HEPATITIS

HEPATITIS

It is an extensive inflammation of the liver tissues caused by viruses, toxic substances, or immunological abnormalities leading to destruction of the liver cell. Hepatitis is the basis for the hepatic cell to degenerate and develop liver necrosis.

Hepatitis can cause proliferation of the Kupffer cells and inflammation of the periportal areas hence it obstruct the flow of bile.

	Hepatitis A	Hepatitis B	Non A, Non B, (Hepatitis C)
Synonyms	ö      Epidemic hepatitis ö      Catarrhal Jaundice ö      Infectious hepatitis	ö      Serum hepatitis ö      Transfusion hepatitis ö      virus, viral hepatitis	ö      Post transfusion
Prognosis	0 – 1% mortality	2 –10% mortality	No data
Carrier state	NO	YES	YES
Risk	ö      Crowding ö      Homosexuals ö      Food handlers ö      Poor sanitation ö      Unsafe water supply ö      e.g. Travelers	ö      multiple sex partners ö      Members of medical team, blood, drug addicts. ö      blood transfusion ö      Promiscuous partners	ö      Blood recipients – blood transfusion received.
Incubation period	2 – 6 wks	6 wks – 6 months	7 weeks – 8 months  or  5 – 6 wks
M.O.T.	ö      Fecal – oral ö      Oral – anal	ö      person to person ö      parenteral          ö      percutaneous ö      placental 3 P’s ö      blood, semen ö      cervical secretions	ö      percutaneous ö      blood transfusion
Source of infection	Feces
Causative Agent	HAV (Hepatitis A virus)	HBV Hepatitis B virus	NANBV or others- > hepatitis C virus
Prevention	ö      proper handwashing ö      sanitation ö      serum food handlers ö      enteric precaution ö      immunization CAN’T DONATE BLOOD.	ö      vaccine ö      sterile disposal needle ö      monogamous sexual partners	ö      Same with hepatitis B except vaccine

Signs and Symptoms

 

1. Pre-icteric stage

·         Flu-like symptoms

·         Slight RUQ pain

·         Anorexia

·         Nausea and vomiting

·         Fatigue

·         Constipation or diarrhea

·         Weight loss

·         Hepatomegaly

·         Spleenomegaly

·         Lymphadenopathy

2. Icteric stage

·         Light colored stools (alcoholic stool)

·         Jaundice – sclera

·         Tea colored urine (dark urination)

·         Pruritus

·         The continued enlargement of the liver is associated with tenderness.

3. Post-icteric

·         Easy fatigability but there is a sense of well-being.

·         The enlargement of liver is gradually decreasing.

·         All the symptoms are gradually subsiding.

Diagnostic Exam

1. All three types

a.)   SGPT (ALT) serum

b.)   SGOT (AST) enzyme      all inc in pre-icteric

c.)   Alkaline phosphate        LF test

d.)   Bilirubin

2. Ultrasound of liver

3. Liver agglutination test

4. Liver biopsy

5. HbsAg – Hepa B

   Anti – HAV – hepa A

   Anti – HCV – hepa B

Treatment

1. Essential phospholipids – Jelapor
2. Sylimarine – helps in liver regeneration

Chronic hepa B antiviral drug

1. Lamivudine (Zeffix) – necrotic hepa B

ö      Inhibit reproduction of  hepa B virus

ö      100 mg/tab OD P.O. x 1 yr

ö      Effective to Asian $5000

2. White people alpha interferon $5000

Nursing Care

1. Provide a quiet and calm room environment. Bed rest.
2. Include high CHON, CHO, and low fat in the diet. This is suggested to simple cases only
3. Increase protein in the diet for faster healing of the damage liver.
4. Increase carbohydrate to restore glycogen reserve needed in energy production.
5. Low fat diet especially when the patient has steatorrhea.
6. Consider oral care for the patient.
7. Provide psychological support
8. Note that it takes 3 – 6 months to1 year before the liver can regenerate.
9. Assess pruritus and apply comfort measures such as cool or warm compress.
10. Apply preventive precautions to prevent the spread of infection.
11. Proper handwashing.
12. Careful handlings of needle.
13. Maintain on prescribe diet.
14. Assess pain level and provide comfort measures.

Prevention

ö      All patients with hepatitis should never donate blood!

ö      Utilize contact precaution when meeting with a person known to have the infection.

Hepa A

ö      Proper hand washing

ö      Good personal hygiene

ö      Sanitary serving of food handlers

ö      Passive immunization  - ISG to exposed individual & prophylaxis for travelers to developed countries

Hepa B

ö      Screen blood donors Hb3Ag

ö      Correct use disposable needles and syringes

ö      Registration of all carriers

ö      Passive immunization ISG – hepatavax B vaccine given in 3 doses.

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Posted in: Communicable Diseases