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INTRODUCTION- hepatitis is a systemic, viral Lecture What is
1. 2min Introduce about infection in which necrosis and inflammation of hepatitis?
hepatitis. liver cells produce a characteristic cluster of
clinical, biochemical, and cellular changes. To date,
five definitive lice health concern. The disease is
important because it is easy to transmit, has high
morbidity, and causes prolonged loss of Function.
2. 2min Define hepatitis .
DEFINITION OF HEPATITIS what are the
Hepatitis is a viral infection of the liver associated LCD definition of
with a broad spectrum of clinical manifestations hepatitis?
from non-symptom-producing infection through
citric hepatitis to hepatic necrosis.
3. 15mi Described types of FIVE TYPES OF HEPATITIS-
n hepatitis and it Type A Hepatitis-Hepatitis A (HAV) is caused by a
causes. ribonucleic acid (RNA) virus of the enterovirus
family.

 Mode of transmission is primarily fecal-oral,

usually through the ingestion of food or
liquids contaminated with the virus.
o Prevalent in underdeveloped
countries or in instances of
overcrowding and poor sanitation.
o Infected food handler can spread the
disease, and people can contract it by
consuming water or shellfish from
contaminated waters.
o Commonly spread by person-to-
person contact and rarely by blood
transfusion.
 Incubation period is 3 to 5 weeks, with the
average being 4 weeks.
 Occurrence is worldwide , usually among
children and young adults.
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 Mortality is 0% to 1%, with recovery as the
rule.

2.Type B Hepatitis

 Hepatitis B (HBV) is a double-shelled

particle containing DNA. This particle is
composed of the following:
o HBcAgâ €”hepatitis B core antigen
(antigenic material in an inner core).
o HBsAgâ €”hepatitis B surface antigen
(antigenic material in an outer coat).
o HBeAgâ €”an independent protein
circulating in the blood.
 Each antigen elicits a specific antibody:
o Anti-HBcâ €”persists during the
acute phase of illness; may indicate
continuing hepatitis B virus in the
liver.
o Anti-HBsâ €”detected during late
convalescence; usually indicates
recovery and development of
immunity.
o Anti-HBeâ €”usually signifies
reduced infectivity.

 Significance:
o HBcAgâ €”found only in liver cells,
not serum.
o HBsAgâ €”usually detected
transiently in blood of 80% to 90%
of infected persons; may be noted in
blood for months or years, indicating
that the patient has acute or chronic
hepatitis B or is a carrier.
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HBeAgâ €”if absent, the patient is an asymptomatic
carrier. If present, it indicates highly infectious
period of acute, active hepatitis. If it persists, it
indicates progression to chronic state.

 Mode of transmission is primarily through

blood (percutaneous and permucosal
route).
o Oral route through saliva or through
breast-feeding.
o Sexual activity through blood,
semen, saliva, or vaginal secretions.
Hepatitis B is recognized as a
sexually transmitted disease.
o Gay men are at high risk.
 Incubation period is 2 to 5 months.
 Occurrence is for all ages, but mostly affects
young adults worldwide.
 Mortality can be as high as 10%, with
another 10% of patients progressing to
carrier status or developing chronic
hepatitis. It is the main cause of cirrhosis
and hepatocellular carcinoma worldwide.

3.Type C Hepatitis-Hepatitis C (HCV) was

formerly called non-A, non-B hepatitis; an RNA
virus.

Mode of transmission in most cases is through

blood or blood products; prior to 1992,
commercial blood was not routinely tested; now,
the rate of transmission through blood
transfusions is less than 1%.
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Found among I.V. drug users and renal dialysis
patients.

Can be transmitted through sexual intercourse.

o Can theoretically be transmitted

through contaminated piercing and
tattooing tools and ink, but
transmission by this route has not
been proven.
 Incubation period varies from 1 week to
several months.
 Occurs in all age-groups.
o Most common form of post
transfusion hepatitis.
o May occur sporadically or in
epidemic proportions.

4.Type D Hepatitis (Delta Hepatitis)-

 Hepatitis D virus (HDV) is a defective RNA

agent that appears to replicate only with the
hepatitis B virus. It requires HBsAg to
replicate.
o Occurs along with HBV or may super
infect a chronic HBV carrier.


o Cannot outlast a hepatitis B
infection.
o May be acute or chronic.
 Mode of transmission and incubation are
the same as for HBV.
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 Occurrence in the United States is primarily
among I.V. drug abusers or multiply-
transfused patients. The highest incidence
exists in the Mediterranean, Middle East,
and South America.
 Mortality€”causes about 50% of fulminate
hepatitis, which has a high mortality.

5.Type E Hepatitis

 A recently identified no enveloped single-

strand RNA virus.
 Mode of transmission is fecal-oral, but
because this virus is inconsistently shed in
feces, detection is difficult.
 Incubation is the same as for HAV.
 Occurrence is primarily in India, Africa,
Asia, and Central America, but may be found
in recent travelers to these areas and is
more common in young adults and more
severe in pregnant women.

4. 10m Enumerate clinical Clinical Manifestations What is the

in manifestations of Type A Hepatitis Lecture clinical
hepatitis. manifestation?
 May have no symptoms.
 Prodromal symptoms: fatigue, anorexia,
malaise, head-ache, low-grade fever,
nausea, and vomiting.
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 Highly contagious during this period,
usually 2 weeks before the onset of
jaundice.
 Icteric phase: jaundice, tea-colored urine,
clay-colored stool, and right upper quadrant
tenderness.
 Symptoms may be mild in children; adults
are more likely to have severe symptoms
and a prolonged course of disease.

Type B Hepatitis

 Symptom onset usually more insidious and

prolonged compared with HAV.
 May be asymptomatic.
 One week to 2 months of prodromal
symptoms: fatigue, anorexia, transient
fever, abdominal discomfort, nausea and
vomiting, headache.
 Extra hepatic manifestations may include
myalgias, photophobia, arthritis, angio
edema, urticaria, maculopapular eruptions,
skin rashes, vacuities.
 Jaundice in enteric phase.
 In rare cases, it may progress to fulminate
hepatic failure, also called fulminate
hepatitis.
 May become chronic active or chronic
persistent (asymptomatic) hepatitis.
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Type C Hepatitis

 Similar to those associated with HBV but

usually less severe.
 Symptoms usually occur 6 to 7 weeks after
transfusion but may be attributed to
another viral infection and not diagnosed as
hepatitis.
 Approximately 50% develop chronic liver
disease and at least 20% progress to
cirrhosis.

Type D Hepatitis

 Similar to HBV but more severe.

Management
5. 10m Describe the All Types of Hepatitis What is the
in management of all management of
types of hepatitis.  Rest according to patient's level of fatigue. LCD Hepatitis ?
 Therapeutic measures to control dyspeptic
symptoms and malaise.
 Hospitalization for protracted nausea and
vomiting or life-threatening complications.
 Small, frequent feedings of a high-caloric,
low-fat diet; proteins are restricted when
the liver cannot metabolize protein by-
products, as demonstrated by symptoms.

 Vitamin K injected subcutaneously if PT is

prolonged.
 I.V. fluid and electrolyte replacement as
indicated.
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 Administration of antiemetic for nausea.
 After jaundice has cleared, gradual increase
in physical activity. This may require many
months.

For HBV patients

 For those patients found to have active viral

replication, treatment with nucleoside
analogs (Epivir) have shown some efficacy.

For HCV patients

 Treatment of the virus with long-acting

injectable interferons in combination with
the oral antiviral ribavirin (Virazole) may
induce a sustained response of undetectable
viral levels in about 50% of people.
 Close monitoring during long treatment
period is imperative.
LCD What is
Complications complication of
6. 5min Enlist the Hepatitis?
complication of  Dehydration, hypokalemia.
hepatitis.  Chronic carrier hepatitis or chronic active
hepatitis.
 Cholestatic hepatitis.
 Fulminant hepatitis (liver transplantation
may be necessary).
 HBV and HCV carriers have a higher risk of
developing hepatocellular carcinoma.
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7. 10min Explain the health Health Maintenance- Lecture What health
maintenance of maintenance are
hepatitis patient.  Identify persons or groups at high risk, such hepatitis
as I.V. drug abusers or their sexual contacts patient?
and those living in crowded conditions with
potentially poor hygiene or sanitation, and
teach them proper hygiene, waste disposal,
food preparation, abstinence or use of
condoms, proper use of needles, and other
preventive measures.
 Educate adolescents about the risk of
piercing and tattooing in transmission of
HCV.
 Encourage vaccination for HBV with series
of three shots (at 0, 1, and 6 months) for
high-risk patients, such as health care
workers or institutionalized persons, as
well as vaccination of all children from birth
or at adolescence.
 Instruct all patients who have received a
blood transfusion to refrain from donating
blood for 6 months (the incubation period
of HBV). After hepatitis infection, blood
should never be given if patient is an HBV
carrier or was infected with HCV.
 Stress the need to follow precautions with
blood and secretions until the patient is
deemed free of HBsAg.
 Explain to HBV carriers that their blood and
secretions will remain infectious.
 For additional information, refer to the local
public health department or the Centers for
Disease Control and Prevention.
 SUBJECT-MEDICAL SURGICAL NURSING
Health talk ON:-
HEPATITIS

SUBMITTED TO- SUBMITTED BY-

MRS.NEELAM PAUL MS.SHAILVIYA STEPHAN

M.SC (DEMONSTRATER) M.SC (N) PRIVIOUS YEAR

GOVT.COLLEGE OF NURSING
 LESSON PLAN

Subject – Medical Surgical Nursing.

Topic - Hepatitis

Class – Msc (N) Ist Year.

Name of Teacher - Mrs. Neelam paul.

Name of student teacher – MS. Shailviya Stephan

No. of participate / Student – 10-15

Language – English AND Hindi

Date – 5-3-2011

Time – 11 AM TO 12PM

Venue – DR.BRAM HOSPITAL

Previous knowledge - Patient are having some knowledge about the hepatitis.
General objective - All the end of my topic patient are able to know about hepatitis.

SPECIFIC OBJECTIVE-
1.Introduce about hepatitis.
2.Define hepatitis .
3.Described types of hepatitis and it causes.
4 .Enumerate clinical manifestations of hepatitis.
5.Describe the management of all types of hepatitis.
6.Enlist the complication of hepatitis.
7.Explain the health maintenance of hepatitis patient.