Hepatitis Gail Lupica Ph D RN CNE Hepatitis

  • Slides: 21
Download presentation
Hepatitis Gail Lupica Ph. D, RN, CNE

Hepatitis Gail Lupica Ph. D, RN, CNE

Hepatitis • Characterized by inflammation and necrosis of hepatic cells. • Severity of symptoms

Hepatitis • Characterized by inflammation and necrosis of hepatic cells. • Severity of symptoms may vary from client to client. Onset of symptoms also varies according to the incubation period of the specific virus.

Hepatitis Three phases: • Pre-Icteric: (also called prodromal) This is the period of maximal

Hepatitis Three phases: • Pre-Icteric: (also called prodromal) This is the period of maximal infectivity. Circulating immune complexes may cause fatigue, anorexia, depression, headache, weight loss, muscle pain, nausea, vomiting, changes in taste and smell, and fever. Right upper quadrant tenderness may be noted.

Hepatitis Icteric: (clinical stage) Characterized by jaundice. There is a defective uptake, conjugation and/or

Hepatitis Icteric: (clinical stage) Characterized by jaundice. There is a defective uptake, conjugation and/or distribution of bile. Bilirubin is diffusing into the tissues. Urine is darker. Stools are clay colored. • Persistent fatigue. • Liver is enlarged and tender.

Hepatitis Post-Icteric: (recovery stage) • Convalescent phase. Jaundice is disappearing, but it does not

Hepatitis Post-Icteric: (recovery stage) • Convalescent phase. Jaundice is disappearing, but it does not mean recovery. • It may last weeks to months.

Diagnosis: • Serologic markers: looks at the presence of antigens and antibodies of infected

Diagnosis: • Serologic markers: looks at the presence of antigens and antibodies of infected persons. All have antigen serologic markers except Hepatitis E. • Liver function tests…. ALT. AST, Bili show disease stage. The higher they are the more acute the disease is. • • WBC count is elevated.

Hepatitis Management: • Rest, Rest -Reduces the metabolic demands of the liver. • Good

Hepatitis Management: • Rest, Rest -Reduces the metabolic demands of the liver. • Good nutrition- High carbo, high k/cal, moderate protein, low fat. (Except if hepatic encephalopathy present, then moderate protein) Avoid all ETOH!!! • Steroid therapy-always controversial. • Anti -emetics

Complications: Chronic Hepatitis: Delayed convalescent period…lasting> 6 months. May last for years. No liver

Complications: Chronic Hepatitis: Delayed convalescent period…lasting> 6 months. May last for years. No liver necrosis occurs so the prognosis is favorable. • Fulminant Hepatitis: Active necrosis of the liver is occurring. Cells don’t regenerate. Very serious and may progress to liver cirrhosis and liver failure

Hepatitis A Transmission: fecal/ oral route (infected human waste) • Contaminated food& water (especially

Hepatitis A Transmission: fecal/ oral route (infected human waste) • Contaminated food& water (especially shellfish) • May be transmitted sexually • May be transmitted by someone with a sub clinical infection • Can be destroyed by bleach and hot temps > 195 F.

Hepatitis A Incubation period: (time from infection to the time when symptoms appear) Short

Hepatitis A Incubation period: (time from infection to the time when symptoms appear) Short 2 -6 weeks (15 -50 days) Vaccine: yes “Havrix” and Vaqta- inactivtaes Hep A virus

Hepatitis A Immune serum globulin: effective • (Provides passive immunity for up to 3

Hepatitis A Immune serum globulin: effective • (Provides passive immunity for up to 3 months) • May give it before anticipated contact, or within first few days of exposure. Seriousness: No carrier or chronic state • Rarely fulminant/deadly • Dx: Anti – HAV antibodies are found

Hepatitis B • Transmission: Infected blood, and body secretions • sweat, tears, semen, vaginal

Hepatitis B • Transmission: Infected blood, and body secretions • sweat, tears, semen, vaginal secretions • Persons at high risk include IV drug users, and fetus of infected mothers. • Health care workers are at high risk! Has a very high titer, which means it’s highly infectious!

Hepatitis B Incubation period: 25 -180 days Vaccine: yes “Heptavax” Given in 3 doses

Hepatitis B Incubation period: 25 -180 days Vaccine: yes “Heptavax” Given in 3 doses over 6 months (the second follows the first after one month, the third is given 6 months after the initial dose. ) • Given to babies at birth. This greatly reduces the risk of babies become carriers of the disease.

Hepatitis B Immune Serum Globulin: Hepatitis B immune globulin • Provides passive immunity for

Hepatitis B Immune Serum Globulin: Hepatitis B immune globulin • Provides passive immunity for those who were exposed to the HBV • The cost is high. Given only when there was known exposure. Seriousness: Up to 10% develop carrier state, or chronic hepatitis. --hepatocellular CA in US. Most cases do clear the virus and then have immunity. Dx: anti HBc Igm or HBs. A

Hepatitis C “non A, non B Hepatitis” “post transfusion hepatitis” Transmission: blood, body fluids

Hepatitis C “non A, non B Hepatitis” “post transfusion hepatitis” Transmission: blood, body fluids • Present in 1% of blood donor population. • Due to screening of blood, risk due to transfusion is now less than 1%.

Hepatitis C • Incubation period: average 7 weeks… • Vaccine: none

Hepatitis C • Incubation period: average 7 weeks… • Vaccine: none

Hepatitis C Immune serum globulin: not used • Seriousness: Increases the incidence of primary

Hepatitis C Immune serum globulin: not used • Seriousness: Increases the incidence of primary liver CA • Most do not clear the virus and a chronic condition develops. • DX: ELISA - initial screening recombinant immunoblot assay= RIBA (more confirmatory) or anti-HCV

Hepatitis D • “Delta Agent” • Transmission: Parenteral route • Same as Hepatitis B.

Hepatitis D • “Delta Agent” • Transmission: Parenteral route • Same as Hepatitis B. Must be positive for the Hbs. A in order to contract Hepatitis D. The HDV is an incomplete strand of RNA that can only affect you if you are a carrier of HBV or have the surface antigen.

Hepatitis D • Incubation period: 14 -56 days, but only if HBV present. •

Hepatitis D • Incubation period: 14 -56 days, but only if HBV present. • Vaccine: yes, same as Hepatitis B • Immune Serum Globulin: Hepatitis B immune globulin • Seriousness: Higher incidence of chronicity and cirrhosis than with Hepatitis B alone.

Hepatitis E • “Enterically transmitted • Non-A Non-B hepatitis” Transmission: fecal/ oral route •

Hepatitis E • “Enterically transmitted • Non-A Non-B hepatitis” Transmission: fecal/ oral route • Only found in US when individuals have visited underdeveloped countries. (Asia, Africa, India, Central America) • Incubation period: 15 -64 days

Hepatitis E Vaccine: none Immune serum globulin: not effective Seriousness: No evidence of chronic

Hepatitis E Vaccine: none Immune serum globulin: not effective Seriousness: No evidence of chronic or carrier state… Self limiting in its course.