1. Republic of the Philippines
Central Luzon Doctors’ Hospital Educational Institution
Romulo Highway, San Pablo, Tarlac City
A.Y. 2013-2014
Prepared By:
Granil, Charmaine C.
Gracia, Mylene
Dela Cruz, Jessica
Escoto, Daniel

2. HEPATITIS
The word hepatitis comes from the Ancient Greek word hepar (root
word hepat) meaning 'liver', and the Latin itis meaninginflammation.
Hepatitis means injury to the liver with inflammation of the liver cells.
How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D,
and E - plus types X and G.
Hepatitis A - this is caused by eating infected food or water. The food or
water is infected with a virus called HAV (Hepatitis A Virus). Anal-oral
contact during sex can also be a cause. Nearly everyone who develops
Hepatitis A makes a full recovery - it does not lead to chronic disease.
Hepatitis B - this is an STD (sexually transmitted disease). It is caused
by the virus HBV (Hepatitis B Virus) and is spread by contact with
infected blood, semen, and some other body fluids. You get Hepatitis B
by:
o Unprotected sexual intercourse with an infected person (unprotected
sex means without using a condom) Using a syringe that was
previously used by an infected person (most commonly happens with
drug addicts and people who inject steroids).
o Having your skin perforated with unsterilized needles, as might be the
case when getting a tattoo, or being accidentally pricked. People who
work in health care risk becoming infected by accident in this way.
Sharing personal items, such as a toothbrush or razor, with an infected
person.
o A baby can become infected through his mother's milk if she is
infected.
o Being bitten by someone who is infected.
The liver of a person infected with Hepatitis B swells. The patient can
suffer serious liver damage due to infection, resulting in cancer. For
some patients the hepatitis becomes chronic (very long-term or lifelong).
Donated blood is always tested for Hepatitis B.

3. Hepatitis C - Hepatitis C is usually spread through direct contact with the
blood of a person who has the disease. It is caused by the virus HCV
(Hepatitis C Virus). The liver can swell and become damaged. In
hepatitis C, unlike hepatitis B, liver cancer risk is only increased in people
with cirrhosis and only 20% of hep C patients get cirrhosis. Feces is
never a route of transmission in hepatitis C. Donated blood is also tested
for Hepatitis C.
Misuse of anesthesia can result in the transmission of hepatitis B and
hepatitis C viruses, researchers reported in the journal Gastroenterology.
The cause of infection tends to be from anesthesia contamination, and
not endoscopy contamination. Experts say that more effort is needed to
better educate the healthcare community about the importance of strict
sterile techniques when using any type of anesthesia.
Hepatitis D - only a person who is already infected with Hepatitis B can
become infected with Hepatitis D. It is caused by the virus HDV
(Hepatitis D Virus). Infection is through contact with infected blood,
unprotected sex, and perforation of the skin with infected needles. The
liver of a person with Hepatitis D swells.
Hepatitis E - a person can become infected by drinking water that
contains HEV (Hepatitis E Virus). The liver swells but there is no long-
term consequence. Infection is also possible through anal-oral sex.
“MODES OF TRANSMISSION”
Transmission of Hepatitis B
Hepatitis B is transmitted through contaminated blood, sweat, tears, saliva, semen,
saliva, vaginal secretions, menstrual blood and breast milk. This can occur when
using the same syringe as an infected person, from blood transfusions prior to 1975
(now screened in most countries), having tattoos or body piercing, from mother to
child during childbirth, during medical procedures, occupational exposure, during
sexual intercourse. Having Hepatitis B does not necessarily mean that he or she is
infectious to other people, only some people with HBV are contagious.

4. Transmission of Hepatitis C
Hepatitis C is transmitted primarily blood to blood contact; a person is infected by
hepatitis C gets that persons blood into their blood stream. Therefore as with
hepatitis B, blood transfusions (prior to 1990 in this case), tattooing and body
piercing, occupational exposure, medical procedures, intravenous drug use. Sexual
contact, anal, oral or genital, has been shown to be an inefficient route of exposure,
as is mother-to-child in childbirth.
Transmission of hepatitis D
Hepatitis D is transmitted in the same way as hepatitis B. Hepatitis D can only
exist with the hepatitis B virus and can be caught either at the same time as HBV
(coinfection) this type is known to clear the body well (90% to 95%). Others get
the HDV separately when they are already infected by HBV, (superinfection), here
70% to 95% go on to have the more serious chronic form of HDV.
What are the signs and symptoms of hepatitis?
Many people with Hepatitis experience either mild symptoms or none at all.
Remember that an infected person's feces are always infectious to other
people. When symptoms appear, they usually do so about 15 to 180 days
after the person has become infected.
The acute phase of hepatitis - symptoms
The initial phase of hepatitis is called the acute phase. The symptoms are
like a mild flu, and may include:
Diarrhea
Fatigue
Loss of appetite
Mild fever
Muscle or joint aches
Nausea
Slight abdominal pain
Vomiting
Weight loss

5. The acute phase is not usually dangerous, unless it develops into the
fulminant or rapidly progressing form, which can lead to death.
As the patient gets worse, these symptoms may follow:
Circulation problems (only toxic/drug-induced hepatitis)
Dark urine
Dizziness (only toxic/drug-induced hepatitis)
Drowsiness (only toxic/drug-induced hepatitis)
Enlarged spleen (only alcoholic hepatitis)
Headache (only toxic/drug-induced hepatitis)
Hives
Itchy skin
Light colored feces, the feces may contain pus
Yellow skin, whites of eyes, tongue (jaundice)
Patient outcomes after the acute phase depend on various factors,
especially the type of hepatitis.
Signs and Symptoms of Acute Hepatitis
In its severe form symptoms of acute hepatitis can make the person feel extremely
ill. Other people think they have flu. Signs and symptoms can include some or all
of the following:
Jaundice Dark, coca-cola colored urine
Fever Light colored stools
Abdominal pain Muscle and joint pains
Poor appetite/li] Rash
Nausea The liver may be enlarged and
tender
Vomiting
Fatigue

6. Signs and symptoms of Chronic Hepatitis
Although signs and symptoms may vary, many people are unaware that anything is
wrong with them, others may have vague symptoms. These may include:
Mild or restless fatigue
Jaundice
Enlarged liver
Unfortunately if chronic hepatitis is not cleared by the body or is not successfully
treated and cured then liver disease or liver failure may result.
Signs and symptoms of Fulminant Hepatitis
A severe but rare form of acute hepatitis it may begin with fatigue and nausea, but
within a few weeks the signs and symptoms are pronounced and are as with acute
hepatitis listed above. About 2 weeks after jaundice develops encephalopathy
develops. Encephalopathy is a state of impaired or altered mental status. In its mild
form there may be:
Some short term memory loss, forgetfulness
Slurring of speech
Small behavioral personality or behavioral changes
Changes in sleep pattern
In its severe form fulminant hepatitis symptoms include:
Severe loss of memory i.e. not knowing the date, year, their name or address,
confusion, inappropriate behavior, poor coordination, Asterixis- uncontrollable
flapping of the hands, Fetor hepaticus- foul smelling breath and coma.
Up to 85% of people with this rare type of hepatitis will die without a liver
transplant.

7. Diagnostic Tests for Hepatitis
Liver Function Tests
These tests show how well the liver is functioning but will not accurately assess
the many and varied functions for which liver is responsible. Tests do check the
level of liver enzymes, transaminases and cholestatic enzymes, bilirubin and liver
protein levels. High levels of transaminases in the blood do not always reveal how
badly the liver is inflamed or damaged. Elevated levels can also occur in genetic
liver disease, liver tumors and heart failure. The normal ranges of AST and ALT
transaminases are around 0 to 40 IU/L and 0 to 45 IU/L respectively.
Liver Proteins and hepatitis
Albumin, prothrombin, and immunoglobulins are checked and abnormal levels are
indicative of severe liver disorder. Prothrombin times, because the liver produces
many of the clotting factors required to stop bleeding needs to be determined.
Liver Biopsy for hepatitis
One of the main and most accurate diagnostic procedures that can determine what
is wrong with the liver and how badly it has been damaged. As most liver diseases
affect the entire organ uniformly, the small sample obtained by biopsy,
generally performed under.

8. Treatments for hepatitis
Hepatitis A - There is no treatment specifically for hepatitis A. Doctor will
advise the patient to abstain from alcohol and drugs during the recovery.
The vast majority of patients with Hepatitis A will recover spontaneously.
Hepatitis B - A patient with Hepatitis B needs to rest. He will require a
diet that is high in protein and carbohydrate - this is to repair damaged
liver cells, as well as to protect the liver. If this is not enough, the doctor
may prescribe interferon. Interferon is an antiviral agent.
Hepatitis C - A patient with Hepatitis C will be prescribed pegylated
interferon and ribavirin.
Patients with chronic hepatitis C who are receiving standard HCV
treatment may benefit significantly by taking vitamin B12 supplements,
researchers reported in the journal Gut. The authors explained that by
adding vitamin B12 to standard treatment, the body's ability to fight the
virus is greatly improved. According to their study results, patients who
are difficult to treat effectively benefit especially well.
Interferon-free treatment for hepatitis C may eventually be possible,
researchers reported in NEJM (New England Journal of Medicine). In a
clinical trial, sofosbuvir was successful in treating Hepatitis C infection.
Sofosbuvir is an oral nucleotide inhibitor of HCV polymerase.
Hepatitis D or E - So far, there is no effective treatment for either
Hepatitis D or E.
Non-Viral Hepatitis - If the patient has non-viral hepatitis, the doctor
needs to remove the harmful substance. It will be flushed out of the
stomach by hyperventilation or induced vomiting. Patients with drug-
induced hepatitis may be prescribed corticosteroids.
PREVENTION OF HEPATITIS
How to prevent Hepatitis A
Wash your hands with soap after going to the toilet

9. Only consume food that has just been cooked
Only drink commercially bottled water, or boiled water if you unsure of
local sanitation
Get a vaccine for Hepatitis A if you travel to places where hepatitis may
be endemic
How to prevent Hepatitis B
Tell the partner if you are a carrier or try to find out whether he/she is a
carrier
Practice safe sex
Only use clean syringes that have not been used by anyone else
Do not share toothbrushes, razors, or manicure instruments
Have a Hepatitis B series of shots if you are at risk
Only allow well sterilized skin perforating equipment (tattoo, acupuncture,
etc.)
How to prevent Hepatitis C
If you are infected do not let others share your toothbrush, razor,
manicure equipment
If you are infected cover open wounds
Do not share needles, toothbrushes, or manicure equipment
If your skin is to be pierced, make sure equipment is well sterilized
(tattoo, etc.)
Go easy on the alcohol
Do not share drug equipment