Hepatitis

Developed by
Cheryl McConnell RN MSN
 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
 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
 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
 Laennec’s – alcohol induced hepatitis
 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
 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
 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 (avg=7weeks)
 90% develop chronic hepatitis
 #1 cause of cirrhosis and liver cancer
 Usually severe signs and symptoms
 Hepatitis D
 Seen with Hepatitis B
 Same contamination
route as Hep B
 Incubation: 14 – 56
days
 Usually
asymptomatic
 Hepatitis E
 Waterborne virus
 Contaminated water in

third world countries =

fecal oral route
 Incubation: 15 – 64

days
 Signs and Symptoms
Abdominal pain
Joint and muscle pain
Change in bowel function
Nausea, vomiting, anorexia
Lethargy, malaise
Fever (Hepatitis A)
Irritability
 More Signs and Symptoms
Jaundice
clay colored stools
dark urine
Pruritis/urticaria
Skin abrasions
Rash
 Diagnostic Data
 Elevated liver enzymes
 ALT

 AST

 Alkaline phosphatase

 Serum Bilirubin
 Urine Bilirubin
 Specific serum antibodies ie:
anti-HAV
 ELISA
 More Diagnostics
 Liver biopsy –
chronic versus
acute
 Extent of liver

damage
 Helps to

determine a
prognosis
 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
 Treatment
 Comfort – decrease odors
 Liver transplant
 Home care
 Infection control
 Long term rehabilitation
 No hepatotoxic agents
 Alcohol, acetaminophen,
 Rest
 Diet
 Prevention Teaching
 What would you teach?