hepatiti.pptx00000097654234332432wzfee56

hepatitis
HEPATITIS
PRESENTED BY
NIHARIKA
11/26/2024
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hepatitis
INTRODUCTION
 Hepatitis is a broad term that means inflammation of liver.
 It is most commonly caused by viruses but also be caused by
drugs(alcohol), chemicals, autoimmune diseases and
metabolic abnormalities.
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hepatitis
ETIOLOGY OF HEPATITIS
Viral hepatitis
Alcoholic hepatitis
Autoimmune hepatitis
Non- alcoholic
steatohepatitis(NASH)
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hepatitis
VIRAL
HEPATITIS
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hepatitis
INTRODUCTION
 Five types of hepatitis have been identified: Hepatitis A, B, C,
D , E.
 Hepatitis A is always an acute, short-term disease, while
hepatitis B, C, and D are most likely to become ongoing and
chronic.
 Hepatitis E is usually acute but can be particularly dangerous in
pregnant women.
 The hepatitis A and E viruses typically cause only acute, or
short-term, infections.
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hepatitis
 Other less common viruses can also cause liver disease.
These include Cytomegalovirus(CMV), Herpes virus,
Rubella virus.
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hepatitis
INCIDENCE
 Viral hepatitis is a major public health concern, 10 millions
cases occur worldwide.
 It is nearly universal during childhood in developing
countries.
 India is a hyperendemic for hepatitis A virus infection.
 Annually over 1 to 2 lakh Indians die due to illness related to
HBV infection.
 Worldwide 170 million people are infected with Hepatitis C
virus(HCV).
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hepatitis
HEPATITIS A(Hep. A)
 A highly contagious liver infection caused by the
hepatitis A virus(HAV).
 Hepatitis A virus is a ribonucleic acid(RNA) virus of the
enterovirus family.
 It can cause acute hepatitis with jaundice. Also cause
acute liver failure. It does not cause long term infection.
 Incubation period is 3-5 weeks with an average of 28
days.
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hepatitis
 It is transmitted primarily through the fecal-oral route.
 Source of infection is Crowded conditions, poor personal
hygiene, Poor sanitation, Contaminated food, water, shellfish,
person with subclinical infections, infected food handlers.
 More prevalent in underdeveloped countries. People who
travel to developing countries more likely to get HepA.
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hepatitis
Sign and symptoms

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hepatitis
Diagnostic Evaluation
Blood tests: 2 kinds of antibodies to the
virus. IgM antibodies and IgG antibodies.
IgM antibodies show acute infection.
IgG antibodies show previous infection or
immunization.
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hepatitis
MANAGEMENT
 There are no drug therapies for the treatment of acute
hepatitisA.
 Rest according to patient’s level of fatigue.
 Hospitalization.
 Small, frequent feedings of a high calorie, low fat diet,
proteins are restricted.
 Vit K injection if PT is prolonged.
 I.V. fluid and electrolyte replacement.
 Antiemetic drugs.
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hepatitis
HEPATITIS B (Hep B)
Hepatitis B virus can cause acute and chronic infection.
Acute hepatitis B infection may last up to 6 months (with
or without symptom) and infected persons are able to pass
these virus during these time.
Chronic hepatitis B is defined as persistence of HBsAg for 6
months or more after acute infection with HBV.
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hepatitis
Contd.
 Incubation period is 2-5 months.
 Hepatitis B virus is a complex structure with 3 distinct
antigens:
1. HBcAg- Hepatitis B core antigen.
2. HBsAg- Hepatitis B surface antigen.
3. HBeAg- An independent protein circulating in the
blood.
 Mode of transmission is mainly sexual contact.
Recognized as STD. It is much more infectious than HIV.
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hepatitis
Further mode of transmission are Parenteral or permuscosal exposure to
blood or blood products, perinatal transmission.
Sources of infection are Contaminated needles, syringes, blood products.
Homosexual men,Tattoo or body piercing with contaminated needles.
Occurrence is for all ages, but mostly affects young adults worldwide.
It is the main cause of cirrhosis and hepatocellular carcinoma worldwide.
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hepatitis
Sign and sympotoms
 Abdominal pain
 Dark urine
 Fever
 Joint pain
 Loss of appetite
 Nausea/ vomiting
 Fatigue
 Jaundice
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hepatitis
 Blood tests: AST, ALT, ALP,GGT, Serum proteins, PT,
Urinary bilirubin, Urinary Urobilinogen, Total serum
bilirubin.
 Serological tests: HBsAg, Anti-HBs, HBeAg, Anti-Hbe,
Anti-HBe IgM,Anti- Hbe IgG, HBV genotyping.
 Liver ultrasound: Transient elastography can show the
amount of liver damage
 Liver biopsy.
 Fibro tests
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hepatitis
MANAGEMENT
 Treatment of acute hepatitis B is indicated only in patients
with severe hepatitis and liver failure. Rest, vitamin
supplements,Avoid alcohol.
 Treatment of chronic hepatitis B :
 Nucleoside and Nucleotide analog such as Tenofovir,
adenofovir, lamivudine.
 Interferon: Standard interferon( Intron A), Pegylated
interferon ( Peglntron,)
 Liver transplant.
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hepatitis
HEPATITIS C(Hep C)
 Hepatitis c virus is an RNA virus.
 Incubation period is 14-180 days(average 56).
 In most cases it is transmitted through blood or blood
products, prior to 1992. It is also transmitted through
unprotected sex, and contaminated or unsterile needles.
 It is found in I.V. drug users and renal dialysis patients.
 It can result in both acute and chronic illness.
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hepatitis
 Chronic HCV infection results in liver cirrhosis.
 There is noVaccine for HCV.
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hepatitis
 Hepatitis C antibody.
 HCV genotyping.
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hepatitis
MANAGEMENT
 In a patient with acute hepatitis C , treatment with Pegylated
interferon within the 12-24 weeks of infection reduce the
development of chronic hepatitis C.
 Chronic HCV: Pegylated interferon, Ribavirin Rebetol,
Protease inhibitors such as incivek and Boceprevir.
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hepatitis
HEPATITIS D OR DELTA HEPATITIS
HDV is a defective single – stranded RNA virus that can not survive on its
own. It requires hepatitis B to replicate.
Incubation period is 2-26 weeks.
Chronic carriers of HBV always at risk for transmission.
Source of infection are same as HBV.
HDV infection is only possible if a person is already infected with hepatitis
B or a person can be infected with both viruses at the same time.
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hepatitis
 Anti-HDV
 HDV Antigen.
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hepatitis
TREATMENT
 Interferon,
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hepatitis
HEPATITIS E
 Hepatitis E virus(HEV) is an RNA virus and incubation
period is 15-64 days.
 HEV has a fecal-oral transmission route.
 Source of infection is contaminated water, poor sanitation.
Found inAsia,Africa and Mexico.
 More common in adults and severe in pregnant women.
 Hepatitis E usually resolves on its own within four to six
weeks. Treatment focuses on supportive care, rehydration
and rest.
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hepatitis
 Anti-HEV IgM and IgG.
 HEV RNA quantification.
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hepatitis
TREATMENT
 There is no specific treatment capable of altering the course
of acute hepatitis E.
 As the disease is usually self-limiting, hospitalization is
generally not required. Hospitalization is required for people
with Fulminant hepatitis.
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hepatitis
PATHOPHYSIOLOGY
 During an acute hepatitis , liver damage is mediated by
cytotoxic cytokines and NK cells.
 CK and cytokines causes lysis of infected hepatocytes. It
leads to cholestasis.
 Liver cells can regenerate after acute infection.
 A chronic viral infection causes chronic inflammation
and cause fibrosis over decades .
 Fibrosis can lead to cirrhosis.
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hepatitis
CLINICAL MENIFESTATIONS
 Clinical menifestations of viral hepatitis are classified into
acute and chronic phases.
 manifestation of acute hepatitis are as follows: Symptom are
similar to mild flu.
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hepatitis
ACUTE HEPATITIS
 Anorexia
 Nausea, vomiting
 Constipation or diarrhea
 Right upper quadrant discomfort
 Malaise
 Fever
 Headache
 Athralgias
 Urticaria
 Hepatomegaly
 Splenomegaly
 Weight loss
 Jaundice
 Dark urine
 Light stools
 Decreased sense of smell or taste
 Bilirubunuria
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hepatitis
CHRONIC HEPATITIS
 Malaise
 Easy fatigability
 Hepatomegaly
 Myalgias
 Elevated liver enzymes.
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hepatitis
COMPLICATIONS
 Dehydration, hypokalemia.
 Chronic carrier hepatitis.
 Cholestatic hepatitis.
 Fulminant hepatitis.
 Liver cirrhosis.
 Hepatocellular carcinoma( HBV, HCV)
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hepatitis
PREVENTIVE
MEASURES
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hepatitis
HEPATITIS A
 GENERAL MEASURES:
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hepatitis
HEPATITIS B & C
 GENERAL MEASURES:
1. Hand washing
2. Avoid sharing toothbrushes and razors.
3. Active immunization: HBV vaccine.
4. HBIG administration for one time exposure such as
needle stick, contact of mucous material.
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hepatitis
 SEXUALTRANSMISSION:
1. Acute exposure: HBIG administration to sexual partner o
HBsAg positive person.
2. Condoms use for sexual intercourse
3. HBV vaccine series administered to uninfected sexual
partners.
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hepatitis
 PERCUTANEOUSTRANSMISSION:
1. Screening for donated blood for HBsAg andAnti-HCV.
2. Use of disposable needles and syringes.
 FOR HEALTH CARE PERSONNEL:
1. Reduce contact with blood or blood containing
secretions.
2. Dispose the needles properly.
3. Use infection control precautions.
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hepatitis
NURSING
MANAGEMENT
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hepatitis
NURSING ASSESSMENT
 Assess for systemic and liver related symptoms.
 Obtain history such as I.V. drug use, sexual activity, travel
and ingestion of possible contaminated food or water to
assess for any mode of transmission of the virus.
 Assess size and texture of liver to detect enlargement or
characteristics of cirrhosis.
 Obtain vital signs, including temperature.
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hepatitis
NURSING DIAGNOSES
 Imbalanced nutrition less than body requirements related to
the effects of liver dysfunction.
 Deficient fluid volume related to nausea vomiting.
 Activity intolerance related to anorexia and liver
dysfunction.
 Risk for injury related to coagulopathy because of impaired
liver function.
 Deficient knowledge
 Disturbed thought process related to encephalopathy.
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hepatitis
NURSING
INTERVETION
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hepatitis
MAINTAINING ADEQAUTE NUTRITION
 Encourage small frequent feedings of high-calorie ,low fat
diet.
 Avoid large quantities of protein during acute phase of
illness.
 Encourage taking pleasing meals in an environment with
minimal noxious stimuli.
 Administer or teach self administration of antiemetic as
prescribed.
 Encourage eating meals in a sitting position to decrease
pressure on the liver.
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hepatitis
MAINTAING ADEQUATE FLUID INTAKE
 Provide frequent oral fluids as tolerated .
 Administer I.V. fluids for patients with inability to maintain
oral fluids.
 Monitor intake and output.
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hepatitis
MAINTAINING ADEQAUTE REST
 Promotes periods of rest during symptom producing phase.
 Provide emotional support and diversional activities.
 Encourage gradual resumption of activities and mild exercise
during convalescent period.
 Promote comfort by administrating analgesics as
prescribed.
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hepatitis
ENSURE PREVENTION OF DISEASE
TRANSMISSION
 Stress importance of proper public and home sanitation and
proper preparation of foods.
 Encourage specific protection for close contacts such as
Immune globulin as soon as possible to household contact of
HAV.
 HBIG as soon as possible to blood or body fluids contact of
HBV patients, followed by HBV vaccine series.
 Explain precautions to patient and family about transmission
and prevention of transmission.
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hepatitis
PREVENTING AND CONTROLLING
BLLEDING
 Monitor and teach patient to monitor and report sign of
bleeding.
 Monitor PT and administerVitamin K as ordered.
 Avoid trauma that may cause bruising.
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hepatitis
MONITORING THOUGHT PROCESS
 Monitor for sign of encephalopathy
 Monitor for worsening of condition from stupor to coma
 Maintain calm, quit environment and reorient patient as
needed.
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hepatitis
PATIENT EDUCATION
 Identify persons or groups at high risk such as I.V. drug abusers
or their sexual contacts and those living in crowded conditions.
 Educate adolescents about the risk of piercing and tattooing in
transmission of HCV.
 Encourage vaccination for HBV with series of 3 shots ( Birth, 1
and 6 months) and high risk patients such as health care
workers .
 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.
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hepatitis
AUTOIMMUNE
HEPATITIS
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hepatitis
It is a chronic inflammation of liver of unknown cause.
It is characterized by the presence of autoantibodies, serum IG.
Majority of patients are women.
There is an autoimmune reaction against normal hepatocytes.
In Diagnosis serological markers are useful such as antinuclear antibodies ,
anti-DNA antibodies.
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hepatitis
Prednisone with or without azathioprine
is the recommended treatment for active
autoimmune hepatitis.
Patient who do not respond to prednisone
and azathioprine , Cyclosporine,
Budesonide, methotrexate are used.
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hepatitis
ALCOHOLIC
HEPATITIS
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hepatitis
 Alcoholic hepatitis is a diseased, inflammatory condition of
the liver caused by heavy alcohol consumption over an
extended period of time.
 Diagnosis are CBC, Liver function tests, Ultrasound, CT
scan, blood clotting tests, liver biopsy.
 Patients needs to stop receive drinking.
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hepatitis
NON-
ALCOHOLIC
STEATOHEPATITIS
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hepatitis
Non-alcoholic steatohepatitis(NASH) is a part of Non-
alcoholic fatty liver disease(NAFLD).
NAFLD is condition where fat builds up in liver not due
to alcohol consumption.
NASH is the inflammation and liver cell damage along
with fat in liver.
NASH is a serious condition that results in cirrhosis,
hepatocellular cancer, liver failure.
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hepatitis
Risk factors for NAFLD are obesity, DM, HTN,
Hyperlipidemia.
In Clinical findings Elevated liver enzymes, liver biopsy,
liver scan ,CT scan, ultrasound.
There is no definitive treatment and therapy is directed at
reduction of risk factors.
Treatment of diabetes, weight reduction and management
of Hyperlipidemia.
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hepatitis
RECAPITULATION
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 What is the causes of hapititis A
 What is the sign and symtoms of hapatitisB
 Q- this from of hepatitis could be passed via contaminated
water of food.
a- A and E
b- C
c- B
d- All of these

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