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What is hepatitis B?
A Viral hepatitis caused by the hepatitis B
It attacks the liver and can cause both acute
and chronic disease.
Can lead to severe illness, cirrhosis,
hepatocellular carcinoma and even death.
The virus is transmitted through contact with
the blood or other body fluids of an infected

Hepatitis B virus, abbreviated HBV, is a
species of the genus Orthohepadnavirus,
which is likewise a part of
the Hepadnaviridae family of viruses.This
virus causes the disease hepatitis B.

Acute vs. chronic hepatitis B

Hepatitis B infection may be either short-lived
(acute) or long lasting (chronic).
Acute hepatitis B infection lasts less than six
months. Your immune system likely can clear acute
hepatitis B from your body, and you should recover
completely within a few months and become
immune. Most people who acquire hepatitis B as
adults have an acute infection, but it can lead to
chronic infection.

Chronic hepatitis B infection lasts six

months or longer. When your immune system
can't fight off the acute infection, hepatitis B
infection may last a lifetime, possibly leading
to serious illnesses such as cirrhosis and liver
The younger you are when you get hepatitis B
particularly newborns or children younger
than 5 the higher your risk the infection
becoming chronic. Chronic infection may go
undetected for decades until a person
becomes seriously ill from liver disease.

Who is at risk?
Have unprotected sex with multiple sex partners or
with someone who's infected with HBV.
Share needles during intravenous (IV) drug use.
Are a man who has sex with other men.
Live with someone who has a chronic HBV
Are an infant born to an infected mother.
Have a job that exposes you to human blood
Travel to regions with high infection rates of HBV,
such as Africa, Central and Southeast Asia, and
Eastern Europe

What are the symptoms?

Abdominal pain.
Cola - colored urine.
Joint pain.
Loss of appetite.
Nausea and vomiting.
Weakness and fatigue.
Yellowing of your skin and the whites of your eyes
Clay-colored stool

Hepa B can be spread by?

Hepatitis B is transmitted through blood
and infected bodily fluids. This can
occur through:
- direct blood-to-blood contact or open
sores of an infected person
- unprotected sex
- unsterile needles
- from an infected woman to her
newborn during the delivery process.

- Human bites from a hepatitis B infected

- Sharing a household with a person with
chronic hepa B infection
-Sharing personal care items such as razor
or toothbrush
-Poor infection control practices in the
medical setting.

Hepa B is not spread by?

Casual contact, like holding hands

Eating food prepared by an infected person
Kissing or hugging
Sharing silverware, plates or cups
Visiting an infected persons home
Sneezing or coughing

Hepatitis Disease Process

How do I know if I have?

Blood tests can determine if you have the virus
in your system and whether it's acute or chronic.
- HBsAg(Hepatitis B surface Antigen)- when this is
positive or reactive, it means that the person
is currently infected with hepatitis B and is able
to pass the infection on to others.
- Anti-HBs(antibody to hepatitis B surface
antigen)-when this is positive or reactive, it
means that the person is immune either from
vaccination or from past infection.

- Anti-HBc(antibody to hepatitis B core antigen)when this is positive or reactive, it means that

the person has had contact with hepatitis B.
This is a very complicated test to explain
because the anti-HBc can possibly be a falsepositive test result.
- IgM anti-HBc-when this is positive or reactive,
it means that the person has had hepatitis B
infection in the past 6 months, indicating acute
hepatitis B infection.

Small sample of your liver for testing (liver

biopsy) to determine whether you have
liver damage.

What will happen if I get

Recovery- 90% of healthy adults who are
infected will recover and be completely rid of
the virus within 6 months.
Chronic infection- 10% of infected adults are
unable to get rid of the virus after 6 months and
are diagnosed as being chronic carriers.
Acute Liver Failure- Less than 1% of infected
adults can have a severe reaction and die from
liver failure within weeks after being exposed.

Is there a cure for hepa B?

Acute hepatitis B
- No medical treatment
Chronic Hepatitis B
-Antivirals: Interferon a 2a ,
Interferon a- 2b,
Adefovir, Entecavir

Liver Cirrhosis and Hepatocellular CA:

Liver transplant

Nursing Management
Planning with the family to help reduce their fears
and anxieties about the spread of disease.
Adequate nutrition and hydration should be
Bed rest may be recommended regardless of other
treatment, until the symptoms of hepatitis subside.
Provide information about disease process,
prognosis and treatment needs.

Hepatitis B in pregnancy
Pregnant women who are infected with hepatitis B
can transmit the virus to their newborns during
pregnancy or delivery.
Almost 90% of these babies will become chronically
infected with hepatitis B at birth if there is.
If a pregnant woman tests positive for hepatitis B,
then she should be referred to a liver specialist for
further evaluation. Although most women do not
have any pregnancy complications as a result of
HBV infection, it is still a good idea to be seen by a

If a pregnant woman tests positive for hepatitis B, her

newborn child must be given two shots in the delivery
room - the first dose of hepatitis B vaccine and one dose
of hepatitis B immune globulin (HBIG). If these two
medications are given correctly within the first 12 hours
of life, a newborn has a 95% chance of being protected
against a lifelong hepatitis B infection. The infant will
need additional doses of hepatitis B vaccine at one and
six months of age to provide complete protection. If a
woman knows that she is infected, it is important that
she tell her doctor to have these two drugs available
when she is ready to deliver. If a baby does not receive
these drugs in time, then there is a greater than 90%
possibility that he or she will become chronically
infected. There is no second chance!

According to the Center for Disease Control

and Prevention (CDC) and the World
Health Organization (WHO), it is safe for an
infected woman to breastfeed her child. All
women with hepatitis B are encouraged to
breastfeed their babies since the benefits of
breastfeeding outweigh the potential risk of
transmitting the virus through breast milk. In
addition, since all newborns should receive
the hepatitis B vaccine at birth, the risk of
transmission is even further reducesd.


is an infection of the female reproductive

PID is one of the most serious
complications of a
sexually transmitted disease in women: It
can lead to irreversible damage to the
uterus, ovaries, fallopian tubes, or other
parts of the female reproductive system,
and is the primary preventable
cause of infertility in women.


Most common causative organisms

Tubercle Bacilli



Acute PID
Typically occurs after onset of menses
Symptoms include:
- Progressive lower abdominal pain with guarding and
rebounding tenderness
- Fever
- Copious purulent cervical discharge
- Nausea and vomiting
- Malaise
- Urinary urgency and frequency
Vaginal itching

Chronic PID

Is manifested by:
Chronic pain
Menstrual irregularities
Exacerbation of acute symptoms

You are more likely to get PID if:

having sex and being under the age of 25

having sex with more than one person
having sex without a condom
using an intrauterine device (IUD) to
prevent a pregnancy
a history of pelvic inflammatory disease

What are the test done?

pelvic exam to check your pelvic organs
cervical culture to check your cervix for infections
urine test to check your urine for signs of blood, cancer,
and other diseases
Pregnancy test
Blood test
Palpation for pain when your cervix is touched
Palpation for tenderness in your uterus, tubes or ovaries
Inspection of fluid coming out of your cervix
Inspection of bleeding from your cervix

Assessing Damage
If your doctor determines that you have pelvic inflammatory
disease, they may run more tests and check your pelvic
area for damage. PID can cause scarring on your
fallopian tubes and permanent damage to your
reproductive organs. Additional tests include:
pelvic ultrasound: imaging test that uses sound waves to
create pictures of your internal organs
endometrial biopsy: outpatient procedure where a doctor
removes and examines a small sample from the lining of
your uterus
laparoscopy: outpatient procedure where a doctor inserts
a flexible instrument through an incision in your
abdomen and takes pictures of your pelvic organs

Problems PID could cause

Ectopic Pregnancy
Chronic Pelvic Pain

Medical Management
Treatment for pelvic inflammatory disease may
- Antibiotics- main treatment for PID
- Laparoscopy- drain antibiotic-resistant abscesses
- Salpingolysis- remove adhesions
- Salpingostomy reopen blocked fallopian tubes
- Salpingo-oophorectomy- for ruptured fallopian
tubes or ectopic pregnancy.
- Hysterectomy- prevent fatal septicaemia

Treatment for your partner. To prevent

reinfection with an STI, advise your sexual
partner or partners to be examined and
treated. Partners can be infected and not
have any noticeable symptoms.
Temporary abstinence. Avoid sexual
intercourse until treatment is completed
and tests indicate that the infection has
cleared in all partners.

Nursing Management

Medicine to relieve pain or dicomfort
IUDs require removal during treatment
Instruction on proper use of antibiotics.
Education on sexual abstinence and
avoidance of tampons and douching
during treatment