Hepatitis

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Hepatitis

• Developed by
• Cheryl McConnell RN MSN

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Pathophysiology of Hepatitis

• Caused by acute viral infection, toxicity, or
  drug induced
• Liver is enlarged and congested
• Distortion of lobular pattern
• Results in increased portal circulation pressure
• Circulation then decreased to liver
• Edema of biliary channels
• Results in obstructive jaundice

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Incidence of Hepatitis

• Hepatitis A 152,000 - 200,000 annually
• Hepatitis B 140,000 320,000 annually
• Hepatitis C 36,000 annually
• 10,000 die annually due to Hep C related
  cirrhosis or cancer
• One half of all liver transplant due to Hep C
• Up to 10 of deliveries transmit HCV to newborn
• Chronic Hepatitis C 4 million

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Types of Hepatitis

• Hepatitis A Infectious, oral/fecal
• Hepatitis B Serum, blood borne
• Hepatitis C Post transfusion, blood
• Hepatitis D with Hep B, drug use
• Hepatitis E - Epidemic, fecal contaminated
  water
• Laennecs alcohol induced hepatitis

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Hepatitis A

• Caused by enterovirus family
• Fecal oral contamination
• Children Group homes
• Shellfish Water/food
• Oral anal sexual activity contamination
• Incubation 15 50 days
• Mild flu-like signs and symptoms
• Immune globulin within two weeks of exposure

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Hepatitis B

• Skin/mucus membrane contamination with blood or
  serous fluid
• Lower concentrations of virus in saliva, semen
  and vaginal fluid
• Incubation 48 -180 days
• Usually young adults between 20 39
• Complications chronic hepatitis, cirrhosis,
  liver cancer

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Hepatitis C

• Skin/mucus membrane exposure with blood or serum
• IV drug use tatoos piercings
• toothbrushes razors blood tx prior to 1992
• needle sticks
• Incubation 21 140 days (avg7weeks)
• 90 develop chronic hepatitis
• 1 cause of cirrhosis and liver cancer
• Usually severe signs and symptoms

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Hepatitis D

• Seen with Hepatitis B
• Same contamination route as Hep B
• Incubation 14 56 days
• Usually asymptomatic

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Hepatitis E

• Waterborne virus
• Contaminated water in third world countries
  fecal oral route
• Incubation 15 64 days

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Signs and Symptoms

• Abdominal pain
• Joint and muscle pain
• Change in bowel function
• Nausea, vomiting, anorexia
• Lethargy, malaise
• Fever (Hepatitis A)
• Irritability

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More Signs and Symptoms

• Jaundice
• clay colored stools
• dark urine
• Pruritis/urticaria
• Skin abrasions
• Rash

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Diagnostic Data

• Elevated liver enzymes
• ALT
• AST
• Alkaline phosphatase
• Serum Bilirubin
• Urine Bilirubin
• Specific serum antibodies ie anti-HAV
• ELISA

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More Diagnostics

• Liver biopsy chronic versus acute
• Extent of liver damage
• Helps to determine a prognosis

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Treatment

• Rest
• Diversional activities
• Diet High in carbs and calories moderate fat
  and protein
• Meds antiemetics ( No Compazine)
• Inferon for Hepatitis B and C
• antivirals for Hepatitis B

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Treatment

• Comfort decrease odors
• Liver transplant
• Home care
• Infection control
• Long term rehabilitation
• No hepatotoxic agents
• Alcohol, acetaminophen,
• Rest
• Diet

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Prevention Teaching

• What would you teach?