Transcript Adult Medical Surgical Nursing 1

Adult MedicalSurgical Nursing
Gastro-intestinal Module:
Hepatitis
Hepatitis: Classification
 An acute or chronic viral infection, which
sets up an inflammatory process in the
liver cells
 Leads to mild, moderate or severe liver
damage which is temporary or chronic
 Very infectious (mode of spread
according to the virus)
 At least 5 known viruses causing
hepatitis: Hepatitis A, B, C, D, E, and
maybe others
Non-viral Hepatitis
 Certain chemicals and drugs can cause
toxic hepatitis with extensive acute liver
cell necrosis:
 Chemicals: Carbon-tetrachloride,
phosphorus, chloroform, gold compounds
 Drugs: Isoniazid, Halothane,
Acetominophen, Methyldopa, certain
antibiotics, anti-metabolites and
anaesthetic agents
Hepatitis A: (HAV)
 RNA virus; spread by faecal-oral route
(contaminated food, water, hands)
 Short incubation (average 30 days)
 Diagnosed by anti-HAV IgM in serum
during an acute attack
 Anti-HAV IgG in serum indicates previous
infection or vaccination = now immune
 Prevention: active immunisation to “at
risk” groups/ travellers to endemic areas.
Immunoglobulin to contacts
Hepatitis B: (HBV)
 DNA virus (much more infectious than
HIV and very damaging to hepatocytes)
 Spread through blood and body fluids
including saliva and vertical transmission:
at birth/ post-natal, not placental transfer
 “At risk” groups are: drug users, sexually
promiscuous, health workers (also risk
from tattoos, haemodialysis, unscreened
blood/ donor organs)
 Long incubation
Hepatitis B: (HBV) (cont)
 Diagnosis: HBsAg (Hep B virus surface
antigen) in blood or secretions
 10% mortality
 10% carrier state: (HBsAg 6-12 months after
illness):
 Maybe no active disease
 Maybe chronic active disease may lead to
cirrhosis or liver cancer
 Anti-HBsAg immunoglobulin in serum shows
previous exposure (disease/ vacc) = immune
Hepatitis B: (HBV) (cont)
 Prevention:
 Life-style changes (drugs, needles,
partners, unprotected sex)
 Vaccination (active or passive immunity).
Infants immunised in endemic areas
 Self-protection for health workers: gloves,
staff awareness of carriers, screening
blood donors, products, disposable
needles/ syringes, “sharps boxes”
 Reporting “needle-stick” injury
Hepatitis C: (HCV)
 RNA virus; also transmitted via blood and
body fluids
 “At risk” groups as HBV
 HCV becomes chronic in 85% of cases
→ cirrhosis or carcinoma of the liver
 Prevention: As for Hepatitis B (HBV)
 Currently no commercial vaccine and no
cure. Antivirals have delayed
progression. With HBV, this is the most
common and serious form of Hepatitis
Hepatitis Delta: (HDV)
 Hepatitis D or Delta is a defective RNA
virus, requiring the presence of HBV
 Either co-infection of HBV and HDV or
super-infection of an HBV carrier with
HDV
 Transmitted as HBV in blood an body
fluids
 Prevention is as for HBV
Hepatitis E: (HEV)
 Enteric hepatitis (HEV) is an RNA virus
 Transmitted by faecal-oral route
 Present in contaminated water, food, on
hands
 Usually responsible for epidemics in
developing countries
 Prevention with improved hygiene and
sanitation, isolation. Vaccination has not
been effective
Hepatitis: Pathophysiology
 Widespread inflammation of liver tissue
causes degeneration and necrosis
 Increased Kuppfer cells (RES) lead to
 Proliferation and enlargement of the liver
and cholestasis →
 Regeneration (if no complications, should
regenerate in an orderly way and resume
normal function)
 HBV and HCV may become chronic
Hepatitis: Progression of
Disease
 Incubation phase:
 Varies according to virus (Hep A and E more
acute onset, B and C more insidious)
 Prodromal/ pre-icteric phase, before jaundice:
(most infective phase for A and E): 1 - 21 days
 Icteric phase:
 Intra-hepatic obstructive jaundice (cholestasis):
still infectious 2 - 4 weeks
 Post-icteric, convalescence (weeks-months)
 Chronic state → liver failure
Hepatitis:
Clinical Manifestations
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Pain in upper right quadrant
Enlarged tender liver
Fever
Malaise and exhaustion
Anorexia, nausea and vomiting
Jaundice, skin and sclera, itching
Dark urine, pale stools
Severity of illness varies
Hepatitis: Diagnosis
 History and clinical picture
 Blood serology for specific hepatitis
antigen or antibody
 Liver function tests and serum bilirubin
 Blood coagulation studies
 Liver biopsy if chronic to determine
extent of damage to hepatocytes (not in
acute state)
Hepatitis: Medical
Treatment
 Depends on classification and severity of
hepatitis:
 (May require ICU and mechanical ventilation in
fulminating B or C) (10% mortality)
 Milder forms require rest and isolation at home
 Fluids ↑; low fat, high glucose and protein diet
 Vitamin B complex and vitamin K supplements
 Antiviral agent (interferon) and anti-HBV (to
prevent chronic state in Hepatitis B)/ slow HBC
Hepatitis: Nursing
Considerations
 Importance of self-protective measures
and informing colleagues
 General nursing care if on bed rest
 Patient education on importance of fluids
and appropriate diet
 Patient and family education about
measures to prevent spread of the virus
Review: Health Education for
Prevention and Protection
 Hand-washing, gloves, appropriate
isolation and separate equipment
 Life-style changes (drugs, needles,
partners, unprotected sex)
 Vaccination (active or passive immunity)
 Self-protection for health workers: gloves,
staff awareness of carriers, screening
blood donors/ blood products, disposable
needles/ syringes, “sharps boxes”
 Reporting “needle-stick” injury