Transcript Hepatitis

Hepatitis
Gail Lupica PhD, RN, CNE
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 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 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 mean recovery.
• It may last weeks to months.
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, 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 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
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 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 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 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 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 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 HBsA
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
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. Must be positive for
the HbsA 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.
• 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
• 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 or carrier
state… Self limiting in its course.