VIRAL HEPATITIS

 It is a systematic, viral infection in

which there is a necrosis and
inflammation of the liver cells.
VIRAL HEPATITIS
 To date, five definitive types of viral
hepatitis have been identified:
hepatitis A, B, C, D, and E.
VIRAL HEPATITIS
 Hepatitis A and E are similar in
mode of transmission (fecal-oral
route) whereas Hepatitis B, C, and D
share many other
characteristics.
Hepatitis A
Hepatitis A
 Hepatitis A is a liver disease caused
by Hepatitis A virus (HAV)
 It is formerly called infectious
hepatitis.
It is caused by an RNA virus of the
Enterovirus family.
TRANSMISSION
Fecal-oral
 The virus is primarily spread when
an uninfected and unvaccinated
person ingests food or water that is
contaminated with the feces of an
infected person
TRANSMISSION
Sexual activity
 This is more likely with oral-anal
contact or anal intercourse with
multiple sex partners
prevalence
Countries with overcrowding and poor
sanitation
 A child or young-adult can acquire
the infection at school through poor
hygiene, hand-to-mouth contact, or
close contact during play.
prevalence
Virus is then carried home where
haphazard sanitary habits can spread it
through the family.
Risk factors
 Poor sanitation
 Lack of safe water
 Use of recreational drugs
 Living in a household with an
infected person
Risk factors
Being a sexual partner of someone
with acute Hepatitis A infection
 Travelling to areas of high
endemicity without being immunized
Incubation period
The incubation period is estimated to
be between 2 to 6 weeks with mean of
approximately 4 weeks.
Clinical manifestations
Many patients are anicteric (without
jaundice) and symptomless
 Mild, flulike upper respiratory tract
infection
 Low grade fever
 Severe anorexia
Clinical manifestations
 Jaundice
 Dark urine
 Indigestion ( nausea, heartburn,
flatulence)
 Strong aversion to taste of cigarettes
smoke or other strong odors
Clinical manifestations
Symptoms tend to clear as soon as the
jaundice reaches its peak, perhaps 10
days after its initial appearance
 Assessment and
diagnostic findings
 Liver and spleen are often
moderately enlarged for a few weeks
after onset
 Hepatitis A Antigen may be found in
stool
 Assessment and
diagnostic findings
 HAV antibodies are detectable in the
serum
PREVENTION
 Scrupulous handwashing
 Safe water supplies
 Proper control of sewage disposal
 Effective (95% to 100% after two to
three doses) and safe HAV vaccines
include Havrix and Vaqta.
PREVENTION
 Immune globulin is recommended for
household members and sexual contact
of people with hepatitis A.
 It can also be given intramuscularly to
those who have not been previously
vaccinated during incubation period
MEDICAL MANAGEMENT
 Bed rest
 Nutritious diet (cereals & grains,
vegetables & fruits, dairy products and
proteins from fish and eggs)
 During period of Anorexia, give small
frequent feeding with IV fluids with
glucose.
MEDICAL MANAGEMENT
 Gradual but progressive ambulation
NURSING MANAGEMENT
Give patient and family specific
guidelines about
 Diet
 Rest
 Follow-up blood work
 Avoidance of alcohol
 Sanitation and hygiene measures
NURSING MANAGEMENT
 Hand washing after bowel movement
and before eating
 Environmental sanitation
Hepatitis B
Hepatitis b
Unlike HAV, the Hepatitis B Virus (HBV)
is transmitted primarily through blood. It
can be found in:
 Blood
 Saliva
 Semen
 Vaginal Secretions
Hepatitis b
It can be transmitted through:
 Mucous membranes
 Breaks in the skin
 Mother through infants but not via
the umbilical vein
Hepatitis b
HB is a DNA virus composed of the
following antigenic particles:
 HBcAg – hepatitis B core antigen
 HBsAg – hepatitis B surface antigen
 HBeAg – an independent protein
circulating in the blood
Hepatitis b
 HBxAg – gene product of X gene
HBV DNA
Hepatitis b
Each antigen elicits its specific
antibody and is a marker for different
stages of the disease process:
 Anti- HBc – antibody to core
antigen of HBV
 Anti-HBs – antibody to surface
determinants on HBV
Hepatitis b
 Anti- HBe – antibody to hepatitis B
e-antigen
 Anti-HBxg – antibody to the
hepatitis B x-antigen
Incubation period
HBV has a long incubation period. (1 to 6
months) It replicates in the liver and
remains in the serum for relatively long
periods.
Risk factors
 Frequent exposure to blood, blood
products or other body fluids
 Health care workers
 Hemodialysis
 Male homeosexual and bisexual
activity
 IV/injection drug use
Risk factors
 Close contact with carrier with HBV
 Travel to or residence in area with
uncertain sanitary conditions
 Multiple sex partners
 Recent history STD
 Receipt of blood or blood products
Clinical manifestations
 Rashes
 Loss of apetite
 Dyspepsia
 Abdominal pain
 Generalized aching
 Malaise
 Weakness
Clinical manifestations
 Jaundice may or may not be present,
but if it occurs, light-colored stools
and dark urine may accompany it.
 Liver may be tender and enlarged to
12 to 14cm vertically.
prevention
Preventing transmission
 Continued screening of blood donors
 Disposable syringes, needles and
lancets
 Good personal hygiene
 Gloves should be worn when
handling blood and body fluids
prevention
 Eating and smoking is prohibited in
the laboratory and in other areas
exposed to secretions, blood or
blood products.
 Patient education
prevention
Active immunization
 It is recommended for people who are
at high risk for Hepatitis B
 Recombivax HB – a yeast-
recombinant vaccine
 Booster are recommended for people
who are immunocompromised
prevention
 A hepatitis B vaccine prepared from
plasma of humans chronically infected
with HBV is used only rarely in
patients who are immunodeficient or
allergic to recombinant yeast-derived
vaccines
prevention
 Both forms of Hepatitis B vaccine are
administered intramuscularly in three
doses.
prevention
Passive Immunity
 Hepatitis B Immune Globulin (HBIG)
provides passive immunity to hepatitis
B and is indicated for people exposed
to HBV who have never had hepatitis
B and never received hepatitis B
vaccine.
prevention
Indications for HBIG
 Inadvertent exposure to to HBAg-
positive blood through percutaneous or
transmucosal routes
 Sexual contact with people positive for
HBAg
prevention
 Perinatal exposure
 MEDICAL MANAGEMENT
 Alpha-interferon
 Side effects: fever, chills,
anorexia, nausea and fatigue
 Lamivudine (Epivir) and Adefovir
(Hepresa)
 MEDICAL MANAGEMENT
 Bed rest then gradually increased
activity
 Adequate nutrition (Proteins are
restricted
 Antacids and antiemetics
 Nursing management
 Assist patient in gradual resumption
of physical activity
 Nurse identifies psychosocial issues
and concerns
 Minimize social isolations
 Reduce fears and anxieties
 Nursing management
 Avoid sexual contact, hygiene,
alcohol.
 Hepatitis C

a viral infection that causes

liver inflammation, sometimes
leading to serious liver damage
The hepatitis C virus (HCV)
spreads through contaminated
blood.
 Symptoms
Bruising easily
Fatigue
Poor appetite
Yellow discoloration of the skin and eyes (jaundice)
Dark-colored urine
Itchy skin
Fluid buildup in your abdomen (ascites)
Swelling in your legs
Weight loss
Confusion, drowsiness and slurred speech (hepatic
encephalopathy)
Spider-like blood vessels on your skin (spider