c S
 is the inflammation of persists for variable periods of

the liver caused byhepatitis B virus. time.

c dhis is considered to be more serious    
than hepatitis A due to the possibility dhe incubation period is 50 to 189 days
of severe complications such as or two to five months with a mean equal
massive damage and to 90 days.
hepatocarcinoma of the liver.

c S
 is a viral infection that
attacks the liver and can cause both
acute and chronic disease.About 2
billion people worldwide have been
infected with the virus and about 350
million live with chronic infection.
c An estimated 600 000 persons die
each year due to the acute or chronic
consequences of "
.
c About 25% of adults who become
chronically infected during childhood
later die from liver cancer or
cirrhosis (scarring of the liver)
caused by the chronic infection.
c dhe "
 virus is 50 to 100
times more infectious than HIV.
c S
 virus is an
important occupational hazard for
health workers.
c S
 is preventable with a safe
and effective vaccine.

    
dhe patient is capable of transmitting the
virus during the latter part of the
incubation period and during the
acute phase. dhe virus may persist in the
blood for many years.
    
1. S
 can be directly
transmitted by person to person
contact via infected body fluids.
2. It can be transmitted though
contaminated needles and syringes.
3. dransmission can occur through
infected blood or body fluids
introduced at birth.
4. It can also be transmitted through
sexual contact.
HBV transmission 
  occur.
1. by fecal-oral route
2. by food-borne or water-borne
transmission
3. by arthropod (mosquito)

  transmission.
dhe disease is caused by Hepatitis B virus "   
1. dhis virus has very limited 1. Scan cause acute or
tissue tropism chronic hepatitis.
2. S infects the liver and 2. Production of virus and high level of
possibly the pancreas. HbsAg is continuous and the particles
3. HbsAg appears in the blood 30 are found in the blood until the
to 60 days after exposure and infections is resolved.
3. dhe virus must be delivered into the
liver to establish infection.
4. dhe virus replicates and large amount
of HbsAg is released into the blood.
5. Initiation of virus replication may be
as short as three days from
acquisition, but symptoms may not
be observed for 45 days or much
longer.
6. Replication of the virus is not
cytopathic and proceeds to relatively
long periods without causing liver
damage.
7. During the acute phase of infection,
the liver parenchyma shows
degenerative changes consisting of
cellular swelling and necrosis,
especially in hepatocytes.

2. Radio-immunoassay-hemaglutinin
test
3. Liver function test
4. Bile examination in blood and urine
5. Blood count
6. Serum transaminase Ȃ SGOd, SGPd,
ALd
7. HbsAg
   
1. Blood donors must be screened to
exclude carriers.
2. Œaution must be observed in giving
care to patients with known HBV.
3. Hands and other skin areas must be
washed immediately and thoroughly
after contact with body fluids.
4. Avoid injury with sharp objects or
instruments.

   5. Use disposable needles and syringes
1. Prodormal period
c [ever, malaise, and anorexia.
c rausea, vomiting, abdominal
discomfort, fever and chills.
c ‰aundice, dark urine, and pale
stools.
c Recovery is indicated by a
decline of fever and improved
appetite.
 [ulminant hepatitis may be fatal
and manifested by severe symptoms
like ascitis and bleeding.
only once and discard properly.
6. Avoid sharing of toothbrush, razor,
and other instruments that may be
contaminated with blood.
7. Observe Dzsafe sexdz.
8. Have adequate rest, sleep, and
exercise and eat nutritious food.
9. S
 vaccine is recommended
for pre-exposure.
10.Hepatitis Immune Globulin (HBIg)
should be administered within 72
hours to those exposed directly
D    
1. Œompliment fixation test

S
S c
c Is caused by a double-shelled virus
containing DrA.
to "
 virus either by
ingestion, by prick or by inoculation.
It spreads primarily through blood
(percutaneous and permucosal
route).
c It can also spread by way of saliva,
breast feeding, or sexual activity
(blood, semen, saliva, or vaginal
secretions.
c £ale homosexuals are at high risk for
infection.
c After acute infection, 10% of patients
progress on to carrier status or
develop chronic hepatitis.
c HBV is the main cause of cirrhosis
and hepatocellular carcinoma.

"

c Incubation period, 2 to 3 months.
c Prodronal symptoms (insidious
onset): fatigue, anorexia, transient
fever, abdominal discomfort, nausea,
vomiting, headache.
c £ay also have myalgias, photophobia,
arthritis, angioedema, urticaria,
maculopapular rash, vasculitis.
c Icteric phase occurs 1 week to 2
months after onset of symptoms
antibody to hepatitis B core antigen
(anti-HBc), anti-HBsAg in
various stages of hepatitis B infection.
4. HŒV: hepatitis Œ antibody may not be
detected for 3 to 6 months after onset
of illness (used for screening);
polymerase chain reaction testing
evaluates viral activity.
5. HDV: anti-delta antibodies in the
presence of HBsAg, or detection of
Ig£ in acute disease and IgG in
chronic disease.
6. Hepatitis E antigen (with HŒV ruled
out).
7. If indicated, prepare the patient for
liver biopsy to detect chronic active
disease, trackprogression, and
evaluate response to therapy.
r   
1. £onitor hydration through intake
and output.
2. £onitor prothrombin time and for
signs of bleeding.

D 

  3. Encourage the patient to eat meals in

1. All forms of hepatitis; elevated serum a sitting position to reduce pressure

transferase levels (aspartate on the liver.

aminotransferase, lanine 4. Encourage pleasing meals in an

aminotransferase); may have environment with minimal noxious

abnormal clotting tests. stimuli (odors, noise, and

2. HAV: radioimmunoassay interruptions).

detects immunoglobulin £ (Ig£) 5. deach self-administration of

antibodies to hepatitis A virus in the antiemetics as prescribed.

acute phase. 6. Encourage rest during

3. HBV: radioimmunoassays detect symptomatic phase, according to

hepatitis B surface antigen (HBsAg), level of fatigue.

7. Encourage diversional activities
when recovery and convalescence are
prolonged.
8. Encourage gradual resumption of
activities and mild exercise during
convalescent period.
9. Stress importance of proper public
and home sanitation and proper
preparation and dispensation of
foods.
10.Encourage specific protection for
close contacts.
11.Explain precautions about
transmission and prevention of
transmission to others to the patient
and family.
12.Warn the patient to avoid trauma that
may cause bruising.
13.Stress the need to follow precautions
with blood and secretions until the
patient is deemed free of HBsAg.
14.Emphasize that most hepatitis is self-
limiting, but follow up is needed for
liver function tests.