Hepatitis

Oi Yee (Kristie) Chow

Jemima Collins
Jessica Gunther
Kayley Martin

General Pathophysiology
Many types and causes of hepatitis
Caused by virus, toxin, bacteria, parasite, autoimmune
Viruses: Hepatitis A/B/C/D/E Virus
Toxin: Alcohol

General Symptoms

Headache
Nausea
Vomiting
Fever
Fatigue
Jaundice
Yellow eyes and skin
Dark urine
Enlarged liver

Hepatitis A, D, E
Hepatitis A:
Transmitted via contaminated food or water
Unique symptoms: diarrhea and loss of appetite
Hepatitis D:
Transmitted via blood, but being infected by Hepatitis
B virus is required
Hepatitis E:
Common in developing countries
Transmitted via contaminated food

Hepatitis B
Transmitted via blood or body fluid
Acute:
Up to 6 months
Full recovery
Chronic:
No symptom
Muscle and joint pain
Liver damage: hepatocellular
carcinoma, cirrhosis
Common among Asian, Pacific
Islanders, and African countries

Hepatitis C
Most common hepatitis in the U.S.
Transmitted via blood and bodily fluids
Sharing needle: most common way to get infected
Acute
80% develop chronic disease
Chronic
Can stay asymptomatic for 15 years
Similar symptoms as hepatitis B
Can lead to liver failure complication

Alcoholic Hepatitis
Overconsumption of alcohol
Symptoms
Portal hypertension
Bleeding hepatic encephalopathy
Common to have malnutrition
Empty calories within alcohol
Might develop other diseases
Pneumonia

Laboratory Tests

Liver Enzymes
(AST & ALT)

Bilirubin

Antibodies

Liver Enzyme Tests (Blood test)

Not specifically to diagnose hepatitis, tests for liver
damage and to monitor hepatitis
Enzymes used are: AST and ALT
Elevated levels of enzymes can indicate acute disease
(hepatitis A) but not chronic disease (hepatitis C)
AST- normal range: 10-34 IU/L
ALT- normal range: 10-40 IU/L

Bilirubin Levels
Not a specific test to diagnosis hepatitis
Can help monitor progress of hepatitis
Normal range: 0.3-1.9 mg/dL

Diagnostic: Antibody Tests and RNA Tests

Antibody Tests (blood tests)
Specific testing for each virus (A, B, and C)
RNA Tests (Hepatitis C)

Antibody tests for Hepatitis A

If IgM anti HAV present
active or recent infection
If IgG anti HAV present...
had infection in the past or has had the hepatitis A
vaccine
protected from the infection

Antibody tests for Hepatitis B

If HBsAg present
infected with hepatitis B, either acute or chronic
If anti-HBs present...
had the hepatitis B vaccine or has recovered from an
acute infection
If anti-HBc present...
past or present infection
present with anti-HBs past infection
present with HBsAg chronic infection

Antibody tests for Hepatitis C

If anti-HCV present (enzyme immunoassay)
exposed to virus at some time in life and has
developed antibodies to fight the virus
does not mean person has chronic hepatitis C
Have to do an RNA test...

RNA Test for Hepatitis C

An RNA assay (qualitative and quantitative) is performed
to test if hepatitis C virus is still in the body and to see
how much of the virus is present (viral load)
If any virus is present positive diagnosis
Viral load used to monitor progress of treatment

Medical Treatments: Prevention

VACCINATIONS
Hepatitis A: Yes
Hepatitis B: Yes
Hepatitis C: NO

Medical and Pharmacological Treatments

HEPATITIS A:
Treat Symptoms/Side effects
Nausea, Fatigue, Liver damage
Small, Frequent Meals
Rest
No Alcohol

Medical and Pharmacological Treatment

HEPATITIS B: (chronic)
Interferon- Injection
16-21 Weeks
Protein made from WBC that signals body to
get rid of Hepatitis B Viruses

Antiviral Drugs
nucleotide/nucleoside analogues
inhibit reproduction of Hepatitis B Viral DNA

Medical and Pharmacological Treatments

HEPATITIS C
OLD Treatment:
Interferon- Injection
Ribavirin- 2x day
Antiviral: non-specific
Side Effects: fatigue, headache,
nausea, insomnia, depression
and anemia

Medical and Pharmacological Treatments

HEPATITIS C Cont.
NEW Treatment:
Interferon- Injection
Ribavirin- 2x day
PLUS
Direct-Acting Antiviral Medications
Genotype 1: boceprevir, telaprevir, simeprevir
All Genotypes: sofosbuvir

Medical and Pharmacological Treatments

LIVER TRANSPLANT:
Last Resort
Liver Damage or Cirrhosis
Chronic: Hepatitis B or C
Whole or Piece of Liver

Case Study: Patient with Hepatitis C

PA is admitted to the hospital with complaints of nausea, vomiting, fatigue, and muscle
aches. Her daughter reports that she has had poor appetite for the past several weeks
and has lost 10 pounds in 1 month. She has been throwing up the majority of her food
over the past several days and has complained that the smell of meat makes her feel
nauseated. She is admitted to the hospital for dehydration. Blood tests reveal PA is
positive for anti-HCV and HCV RNA. She is diagnosed with chronic Hepatitis C. The
nurse reports that she attempts to eat soups, plain breads, and apple sauce provided at
meals but leaves meats, vegetables, and raw fruits untouched.
52 yo female; Dx: Chronic Hepatitis C
Ht. 56, 112#; UBW 122#

Case Study: Patient with Hepatitis C

PA is admitted to the hospital with complaints of nausea, vomiting, fatigue, and muscle
aches. Her daughter reports that she has had poor appetite for the past several weeks
and has lost 10 pounds in 1 month. She has been throwing up the majority of her food
over the past several days and has complained that the smell of meat makes her feel
nauseated. She is admitted to the hospital for dehydration. Blood tests reveal PA is
positive for anti-HCV and HCV RNA. She is diagnosed with chronic Hepatitis C. The
nurse reports that she attempts to eat soups, plain breads, and apple sauce provided at
meals but leaves meats, vegetables, and raw fruits untouched.
52 yo female; Dx: Chronic Hepatitis C
Ht. 56, 112#; UBW 122#

PES Statements
Inadequate energy-protein intake related to nausea,
vomiting, and poor appetite as evidenced by daughters
and nurses reports.
Inadequate fluid intake related to persistent vomiting as
evidenced by dehydration.
Unintended weight loss related to poor appetite as
evidenced by severe weight loss of 10lbs in 1 month.

Nutrition Concerns for Hepatitis C

Underweight
Poor immune system
Muscle deterioration
Malnutrition

Overweight
Fatty liver disease
Exacerbation/advancement of cirrhosis
Interference with treatment

Nutrition Tips
Do...

Eat small, frequent meals

Eat soft, mild, room temp foods
Drink plenty of fluids
Add liquid meals (Ensure, Boost)
Maintain appropriate vitamin &
mineral intake
Maintain adequate protein intake
Include physical activity
Achieve healthy BMI
Consume healthy, balanced diet

Dont...

Drink alcohol
Eat processed foods
Eat excessive sugar
Eat raw/undercooked shellfish
Ingest excessive amounts of
Iron
Niacin
Vitamin A
Vitamin D
Vitamin C
Take supplements without first
obtaining a professional opinion

Question #1
What type of test can diagnose a specific hepatitis
virus?
a. Bilirubin test
b. Liver enzyme test
c. Antibody test
d. Liver panel test

Question #1 Answer
Which type of test can diagnose a specific hepatitis
virus?
a. Bilirubin test
b. Liver enzyme test
c. Antibody test
d. Liver panel test

Question #2
Which of the follow hepatitis viruses is not
primarily transmitted by blood?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D

Question #2 Answer
Which of the follow hepatitis viruses is not
primarily transmitted by blood?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D

Question #3
Which of the following Hepatitis viruses does not
have a vaccine?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C

Question #3 Answer
Which of the following Hepatitis viruses does not
have a vaccine?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C

References
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