Viral

Hepatic
Disorders
JAMAICA JOY J. SIMACAS, RN, MSN
Hepatitis is an acu te or ch ron ic
in flam m ation of th e liver an d can b e
cau sed b y a variety of differen t u ses,
ch em ical or dru g reaction , or oth er
disease.
T ype of Viral Hepatitis
● Hepatitis A Viru s
○ A ccou n ts for 2 0 -2 5 % of clin ical h epatitis in developed
cou n tries
○ E tiolog y -R N A viru s of th e en teroviru s fam ily
○ T ran sm ission
■Feco-oral rou te
■In g estion of food in fected
■Fou n d w ith overcrow din g an d poor san itation
■P oor h an d h yg ien e,h an d to m ou th con tact
■In fected food h an dler
■O ral & an al in tercou rse
○In cu b ation P eriod
■1 5 -5 0 days w ith a m ean of 2 8 -3 0
days period.
■Illn ess period is 4 -8 w ks
■M ortality rate -0 .5 % in <4 0 yrs 1 -2 %
in > 4 0 yrs
C lin ical m an ifestation s
■A n icteric
■an d sym ptom less
■Low g rade fever,h eadach e
■A n orexia,ab dom in al pain
■N au sea an d vom itin g (du e to toxin s released to detoxify
viru s)
■J au n dice an d dark u rin e,clay-colou red stools
■In dig estion ,h eartb u rn an d flatu len ce
■A version to stron g odors
■G en eralized w eakn ess
■A ll th ese clear w ith in 1 0 days 2 0
○A ssessm en t an d diag n ostic fin din g s
■Hepatom eg aly an d splen om eg aly for few
days
■Hepatitis A viru s fou n d in stool for 7 -1 0
days b efore illn ess an d 2 -3 w eeks after
sym ptom s appear.
■HA V an tib odies detected in seru m
■R aised Ig M ,Ig G A n tib
■odies
■E levated liver en zym es
■U ltrasou n d
■C T scan
■M R I
○ P reven tion
■Han d w ash in g
■S afe food an d w ater su pply
■Vaccin e
■Im m u n og lob u lin g iven IM w ith in 2
w ks of exposu re for th ose w h o n ever
h ad vaccin e
○ M edical m an ag em en t
■B edrest du rin g acu te stag e
■IV fliu ds w ith g lu cose
■R estrict activities to preven t fatig u e
w orsen in g
■A n tiem etics
■Im m u n og lob u lin
○ N u rsin g m an ag em en t
■G u idelin es ab ou t
■Diet(low fat,flu id b alan ce)
■R est
■Follow -u p of b lood w ork
■Im portan ce of avoidin g of alcoh ol
■S an itation
■T each fam ily m em b ers
● Hepatitis B Viru s
○ T ran sm ission
■B lood
■P ercu tan eou s an d perm u cosal
■M oth er to ch ild
○ In cu b ation period 1 -6 m on th s
○ R ecovery-9 0 % recovery spon tan eou sly.
○ R isk Factors
■Health profession als: su rg eon s,lab
w orkers,n u rses,den tist,respiratory
th erapist an d staff w orkin g in
h em odialysis an d on colog y u n it
■E xposu re to b lood an d b lood produ cts
■Hem odialysis
■M ale h om osexu al
■IV dru g u sers
■M u ltiple sex partn ers
■B lood tran sfu sion s
○ C lin ical m an ifestation s
■In sidiou s on set b ecau se of lon g prolon g ed
in cu b ation
■Fever an d respiratory sym ptom s are rare
■A rth ralg ia an d rash es
■Loss of appetite & dyspepsia
■A b dom in al pain an d g en eralized ach es
■M alaise an d w eakn ess
■J au n dice m ay or m ay n ot b e eviden t
■Lig h t colored feces an d dark u rin e(if jau n dice
occu rs)
■Hepatom eg aly 1 2 -1 4 cm s vertically an d ten dern ess
■S plen om eg aly in few
■P osterior cervical lym ph n odes
○ A ssessm en t an d diag n osis
■S pecific an tib ody in seru m like HB cA g ,HB sA g ,
HB eA g ,HB xA g
■HB sA g appears in th e circu lation in 8 0 % -9 0 % of
in fected patien ts,1 -1 0 w ks after exposu re & 2 -8 w ks
b efore th e on set of sym ptom s
■HB V DN A detected
■HB cA g Is n ot alw ays detected in seru m
○ P reven tion
■P reven tin g tran sm ission
■S creen in g of b lood don ors
■U se of disposab le n eedles
■G ood protection du rin g b lood collection
■W ork areas disin fected daily
■U se protective devices w h en n eeded
■P atien t edu cation
■Discou rag e b lood don ation
■A ctive im m u n ization
■R ecom m en ded for h ig h risk in dividu als
■C om b in ed h epatitis A & B vaccin e for >1 8 years
■P assive im m u n ity
■Hepatitis B im m u n e g lob u lin
■U sed for th ose exposed to viru s an d
n ot taken vaccin e b efore
■U sed for n eedle stick in ju ries,
perin atal exposu re
○ M edical m an ag em en t
■A lph a in terferon as th e sin g le m odality of
th erapy.
■E n h an ce b ody's im m u n e activity
■5 m illion u n its daily/1 0 m illion u n its 3 tim es a
w eek for 4 -6 m on th s
■R esu lts in rem ission in 1 /3 rd patien ts
■P rolon g ed cou rse m ig h t h ave addition al
b en efits
■S ide effects-fever,n au sea,m yalg ia,fatig u e,
b on e m arrow su ppression ,th yroid dysfu n ction ,
alopecia an d delayed in fection
■A n tiviral ag en ts
■Dru g s h elp con trol disease
prog ression b y su ppressin g viral
reprodu ction in liver
■O n ce daily for years
■B ed rest: U n til h epatom eg aly
an d seru m b iliru b in falls.
■A n tacids an d an ti-em etics
■F lu id th erapy
■N u tritiou s diet
■N u tritiou s diet
○ N u rsin g m an ag em en t
■S ym ptom atic su pport
■G radu al resu m ption of ph ysical activity
■A dvice avoidan ce of sexu al activity
■M in im ize social isolation
■R edu ce fear an d an xiety b y proper explan ation of
treatm en t plan s
Hepatitis C
○P revalen ce
■A du lts, 4 0 -5 9 yrs A frican -
A m erican s
■C au se for death – h epatocellu lar
carcin om a
○R isk factors
■IV dru g u sers
■M u ltiple sex partn ers
■Freq u en t b lood tran sfu sion s
■Health care person n el
■Hem odialysis
■B orn e to h ep C – in fected m oth er
○In cu b ation period: 1 5 -6 0 days
○C lin ical cou rse of disease
■It is sim ilar to Hep B
■S ym ptom s are m ild
■C h ron ic carrier state occu rs
freq u en tly
■In creased risk of cirrh osis an d
can cer
○M an ag em en t
■A void alcoh ol
■A void h epatotoxic dru g s
■C om b in ation of an tiviral - rib avirin
■in terferon is effective- peg ylated
in terferon -I in jection each w eek
■S creen in g b lood don ors redu ces
risk
Hepatitis D
○E tiolog y
■S m all circu lar R N A viru s,delta viru s.
■It is also called su b viral satellite
■C an propag ate on ly w ith th e h elp of an oth er
viru s.
■It can occu r w ith HB V an d b y su perin fection
○R isk factors
■In traven ou s dru g u sers
■Hom osexu al an d m u ltiple sex aprtn ers
■U n screen ed b lood tran sfu sion s
■Hem oph iliacs an d oth er clottin g
disorders patien t
○M ode of T ran sm ission
■B loodb orn e
■P ercu tan eou s
■P erm u cosal
■S exu al
■R arely perin atal
○P ath og en esis
■Lim ited on ly to liver
■C an replicate on ly in liver
■Histolog ical ch an g es resu lts in
h epatocellu lar n ecrosis an d
in flam m ation
○ C lin ical featu res ■Vom itin g
■Fou n d on ly in acu te ■Loss of appetite
ph ase of disease ■Headach e
■M ild fever ■Dizzzin ess
■J au n dice ■lig h t colored stools &
■M u scle ach e m ay con tain pu s
■Dark u rin e ■S pleen om eg aly
■N au sea ■P ru ritis
○Diag n ostic evalu ation
■U sin g radioim m u n oassay or
en zym e im m u n oassay kits
■P C R -can detect 1 0 -1 0 0 copies of
HDV g en om e
■Ig M in seru m
■A n ti HDV an tib odies presen t
○ P reven tion
■In form in g sex partn er an d safe sex
■Hepatitis B vaccin e
■Don’t sh are razor,tooth b ru sh an d person al
articles
■Im m u n ization w ith recom b in an t pu rified
HDA g -S provide com plete protection
○ M an ag em en t
■M assive doses of In terferon
■9 -1 2 m illion u n its 3 tim es a w eek*1 2 m on th s
■5 m illion u n its daily*1 2 m on th s
■A n tivirals are in effective
■Liver tran splan tation
■Im m u n e proph ylaxis
■Vaccin ation ag ain st HB V protects Hepatitis D
Hepatitis E Viru s
○E tiolog y: a positive sin g le stran ded R N A
○M ode of T ran sm ission
■Feco-oral
■A n im als as reservoirs
■C on su m in g w ild b oar an d deer m eat
■R isk factors: h ig h est am on g
adolescen ce an d adu lts
○ Clinical ■ Abdominal
manifestations tenderness
■ Weakness ■ Nausea,
■ Fatigue vomiting,
■ Fever diarrhea
■ Right upper ■ Sore throat ■ Wt loss
abdominal ■ Joint pain ■ Jaundice,
pain ■ Malaise brown
urine, clay
stools
○ Diag n ostic evalu ation
■E levated an tib odies of h ep E - R T -P C R
○ P reven tion
■Im provin g san itation
■P roper disposal of h u m an w aste
■G ood stan dards of pu b lic w ater su pply
■P erson al h yg ien e & san itary food preparation
■Vitam in su pplem en ts
■Diet- h ig h carb oh ydrates
Hepatitis G
○ E tiolog y: relative of h epatitis C viru s
○ R isk factors
■T h ose g ettin g repeated tran sfu sion s
■IV dru g u sers
■M oth er to n ew b orn
■S exu al tran sm ission
○ Diag n ostic evalu ation
■DN A testin g
○M an ag em en t
■N o specific treatm en t
■B edrest
■A void alcoh ol
■B alan ced diet
○P rog n osis: It is m ild illn ess an d does n ot last
lon g
● N u rsin g in terven tion s
○ O b serve stan dard precau tion s to preven t disease
tran sm ission .
○ P rovide rest periods th rou g h ou t th e day.
○ S ch edu le treatm en ts an d tests so th e patien t can rest
b etw een activities.
○ T o h elp th e patien t m ain tain an adeq u ate diet,avoid
overloadin g h is tray.
○ A dm in ister su pplem en tal vitam in s an d com m ercial
feedin g s,as ordered.
○ P rovide adeq u ate flu id in take at least 4 liters of liq u id daily.
• O b serve th e patien t for desired an d adverse effects of
m edication .
○ R ecord th e patien t’s w eig h t daily,an d keep accu rate in take
an d ou tpu t records.
○ W atch for sig n s of com plication s,su ch as ch an g es in level of
con sciou sn ess,ascites,edem a,deh ydration ,respiratory
prob lem s,m yalg ia,an d arth alg ia.
○ T each th e patien t ab ou t th e diseases,its sig n s an d
sym ptom s,an d recom m en ded treatm en ts.
○ E xplain all th e n ecessary diag n ostic tests.
○ S tress th e im portan ce of con tin u ed m edical care.
● Hom e care teach in g
○ W ash h an ds after u rin atin g an d h avin g a b ow el
m ovem en t.
○ Do n ot sh are person al articles e.g . b ru sh ,razor.
○ Do n ot sh are u ten sils,cig arettes an d food
○ U se disposab le syrin g es e.g . vitam in B 1 2 in jection s
○ U se con dom for sexu al in tercou rse
○ Do n ot don ate b lood
○ A void alcoh ol at least for 6 m on th s-1 year
○ A void con tact w ith in du strial toxin s Take acetam in oph en
on ly as prescrib ed
○ Hepatitis im m u n e g lob u lin an d vaccin e for fam ily
m em b ers
T HA N K Y O U
AND
G O D B LE S S !!!!!