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  2. 2. Definition : <ul><li>inflammation of the liver caused by virus or bacterial infections or continuous exposure to alcohol, drugs or toxic chemicals </li></ul><ul><li>result from an autoimmune disorder, in which the body mistakenly sends disease-fighting cells to attack its own healthy tissue. </li></ul><ul><li>liver reduces the ability to perform life-preserving functions </li></ul>
  3. 3. Types of Hepatitis <ul><li>Toxic hepatitis </li></ul><ul><li>Alcohol Hepatitis </li></ul><ul><li>Viral Hepatitis </li></ul>
  4. 4. 1. Toxic hepatitis <ul><li>Definition </li></ul><ul><li>it can be caused by drugs, alcohol, industrial toxins, and plant poisons. </li></ul><ul><li>Clinical manifestation: </li></ul><ul><ul><li>- anorexia </li></ul></ul><ul><ul><li>- nausea and vomiting </li></ul></ul><ul><ul><li>- lethargy </li></ul></ul><ul><li>Nursing Intervention : </li></ul><ul><ul><li>educate the patient regarding the following: </li></ul></ul><ul><li>- danger of using injudicious use of material that are known to be injurious to the liver. </li></ul><ul><li>need of well-balance diet that is protective to the liver </li></ul><ul><li>minimal or no alcohol intake </li></ul><ul><ul><li>- promote comfort </li></ul></ul><ul><ul><li>- maintain normal fluid and electrolyte imbalance </li></ul></ul><ul><ul><li>- promote rest </li></ul></ul>
  5. 5. 2. Alcohol Hepatitis <ul><li>It may be acute or chronic. it is also reversible and is the frequent cause of people with cirrhosis. It is caused by parenchymal necrosis resulting from heavy alcohol consumption. </li></ul>
  6. 6. Viral Hepatitis
  7. 7. Hepatitis A Virus (HAV) <ul><ul><li>formerly known as infectious hepatitis </li></ul></ul><ul><ul><li>caused by Hepatitis A virus which is transmitted through fecal-oral route via contaminated food or drinking water.. </li></ul></ul><ul><ul><li>Common in places with poor hygiene standards, </li></ul></ul><ul><ul><li>usually contracted in early childhood. </li></ul></ul><ul><ul><li>does not have a chronic stage and does not cause permanent liver damage. </li></ul></ul><ul><ul><li>The Hepatitis A virus (HAV) is a Picornavirus; it is non-enveloped and contains a single-stranded RNA packaged in a protein shell. </li></ul></ul><ul><ul><li>virus is resistant to detergent, acid (pH 1), solvents, drying, and temperatures up to 60oC. It can survive for months in fresh and salt water. </li></ul></ul>
  8. 8. <ul><li>MODE OF TRANSMISSION </li></ul><ul><li>fecal-oral route and often occur in conditions of poor sanitation and overcrowding. </li></ul><ul><li>It can be transmitted by the parenteral route but very rarely by blood and blood products. </li></ul><ul><li>Ingestion of shellfish cultivated in polluted water is associated with a high risk of infection. </li></ul>Incubation period : 15-50 days(ave: 28-30 days) Onset: Abrupt <ul><li>Treatment : </li></ul><ul><li>no specific treatment for </li></ul><ul><li>advised to rest, avoid fatty foods and alcohol eat a well-balanced diet, and stay hydrated. </li></ul>Symptoms : Fatigue Fever Abdominal pain Nausea Diarrhea Appetite loss Depression Jaundice Sharp pains in the right-upper quadrant of the abdomen Weight loss Itching
  9. 9. <ul><li>Diagnostic Exams: </li></ul><ul><li>IgM </li></ul><ul><li>IgG </li></ul><ul><li>ALT </li></ul>PREVENTION -Personal Hygiene -Water-supply -Animal Care -Active immunization (Havrix) -Passive immunization
  10. 10. Hepatitis B virus
  11. 11. definition <ul><li>- live in the blood or other body fluids such as saliva, semen, urine, feces, and pleural fluids. </li></ul><ul><li>- it is common to young adults </li></ul><ul><li>- Hepatitis B virus infection may either be acute or chronic </li></ul><ul><li>- Chronic infection with Hepatitis B virus may be either asymptomatic or may be associated with a chronic inflammation of the liver (chronic hepatitis), leading to cirrhosis over a period of several years </li></ul>
  12. 12. Mode of transmission: <ul><li>Unprotected sexual intercourse </li></ul><ul><li>Blood transfusion </li></ul><ul><li>Sharing or re-use of infected needle </li></ul><ul><li>Vertical transmission </li></ul><ul><li>Body secretions of an infected person enter into the break of the skin of uninfected person. </li></ul>
  13. 13. Lab Exams <ul><li>Liver tests — Liver tests are blood tests that provide </li></ul><ul><li>information about the presence of liver damage and help </li></ul><ul><li>determine the severity of damage and whether it has stopped </li></ul><ul><li>or is ongoing. </li></ul><ul><li>Alanine and aspartate aminotransferases </li></ul><ul><li>Bilirubin </li></ul><ul><li>Albumin — Low blood levels of albumin, a protein synthesized by the liver, often signal chronic liver damage. </li></ul><ul><li>Prothrombin time — An abnormally long prothrombin time (a measure of the time required for blood clotting) or high international normalized ratio (INR, another way of reporting prothrombin time) suggests more severe liver damage. The results of a prothrombin time are the best predictor of outcome in acute hepatitis B. </li></ul>
  14. 14. <ul><li>Hepatitis markers —  markers include substances produced by the hepatitis B virus (called antigens) and substances produced by the immune system to control and eliminate the virus (called antibodies). </li></ul><ul><li>Hepatitis B surface antigen — In acute hepatitis, HBsAg can be detected soon after infection. In chronic hepatitis, HBsAg can be detected for many years, and HBsAb may never appear. </li></ul><ul><li>Hepatitis B e antigen — Hepatitis B e antigen (HBeAg) is present when the hepatitis B virus is actively multiplying . </li></ul><ul><li>Hepatitis B virus DNA — Detection of hepatitis B virus DNA in a blood sample signals that the virus is actively multiplying. </li></ul><ul><li>Antibodies to Hepatitis B core antigen — In acute hepatitis, a specific class of antibodies (IgM) directed against the hepatitis B core antigen (anti-HBc) appears early in infection. There are two classes of this antibody (core IgG and core IgM). The IgM class appears first during the acute phase of hepatitis and then gradually switches to the IgG type. </li></ul>
  15. 15. Hepatitis B <ul><li>Diagnostic Exam: </li></ul><ul><li>The tests, called assays, for detection of hepatitis B virus infection involve serum or blood tests that detect either viral antigens (proteins produced by the virus) or antibodies produced by the host. Interpretation of these assays is complex. </li></ul><ul><li>The hepatitis B surface antigen ( HBsAg ) is most frequently used to screen for the presence of this infection. It is the first detectable viral antigen to appear during infection. However, early in an infection, this antigen may not be present and it may be undetectable later in the infection as it is being cleared by the host </li></ul><ul><li>PCR tests have been developed to detect and measure the amount of viral nucleic acid in clinical specimens. These tests are called viral loads and are used to assess a person's infection status and to monitor treatment. </li></ul>
  16. 16. Treatment: <ul><li>antiviral drugs </li></ul><ul><li>lamivudine (Epivir), </li></ul><ul><li>adefovir (Hepsera), </li></ul><ul><li>tenofovir (Viread), </li></ul><ul><li>telbivudine (Tyzeka) </li></ul><ul><li>entecavir (Baraclude) </li></ul><ul><li>the two immune system modulators interferon alpha-2a and pegylated interferon alfa-2a (Pegasys). </li></ul>
  17. 17. Hepatitis C virus (HCV) <ul><li>- non hepa A and non hepa B type of hepatitis </li></ul><ul><li>- is a slowly progressing infection that is spread by the intravenous drug users </li></ul><ul><li>- is a blood-borne infectious disease that is caused by the hepatitis C virus ( HCV ), affecting the liver. The infection is often asymptomatic, but once established, chronic infection can cause inflammation of the liver (chronic hepatitis). </li></ul><ul><li>- No vaccine against hepatitis C is available. </li></ul><ul><li>- An estimated 150-200 million people worldwide are infected with hepatitis C. </li></ul>
  18. 18. <ul><li>Diagnostic Exams: </li></ul><ul><li>Liver function tests (LFTs) such as (ALT) & (AST) normalization, as well as plasma HCV-RNA clearance (this is known as spontaneous viral clearance ). </li></ul><ul><li>Treatment: </li></ul><ul><li>Current treatment is a combination of pegylated interferon alpha (brand names Pegasys and PEG-Intron) </li></ul><ul><li>antiviral drug ribavirin for a period of 24 or 48 weeks </li></ul><ul><li>Prevention: </li></ul><ul><li>Avoid sharing drug needles or any other drug paraphernalia including works for injection or bills or straws </li></ul><ul><li>Avoid unsanitary tattoo methods </li></ul><ul><li>Avoid unsanitary body piercing methods </li></ul><ul><li>Avoid unsanitary acupuncture </li></ul><ul><li>Avoid needlestick injury </li></ul><ul><li>Avoid sharing personal items such as toothbrushes, razors, and nail clippers. </li></ul><ul><li>Use latex condoms correctly and every time you have sex if not in a long-term monogamous relationship </li></ul>
  19. 19. 4. Hepatitis D virus (HDV) <ul><li>DEFINITION </li></ul><ul><li>found in blood </li></ul><ul><li>Hepatitis D infection can only occur with a concomitant infection with Hepatitis B virus because it uses the Hepatitis B virus surface antigen to form a capsid. </li></ul><ul><li>common in young adults </li></ul><ul><li>is a disease caused by a small circular RNA virus (Hepatitis delta virus or hepatitis D virus, HDV). HDV is considered to be a subviral satellitebecause it can propagate only in the presence of another virus, the hepatitis B virus (HBV). </li></ul>Incidence: common in Mediterranean countries, sub-Saharan Africa, the Middle East, and countries in the northern part of South America. In all, about 20 million people may be infected with HDV. Mode of Transmission: They have the same mode transmission as of the HBV. Person who are infected with HBV are susceptible to HDV infection. Incubation Period : unknown Onset: insidious Prevention: Hepatitis B vaccine
  20. 20. 5. Hepatitis E virus (HEV) <ul><li>DEFINITON: </li></ul><ul><li>is a viral hepatitis (liver inflammation) caused by infection with a virus called hepatitis E virus (HEV). </li></ul><ul><li>Onset: Abrupt </li></ul><ul><li>Prevention: </li></ul><ul><ul><li>Improving sanitation is the most important measure </li></ul></ul>
  21. 21. Etiology <ul><ul><ul><li>Toxic Hepatitis : Toxic Biproducts from drugs, foods and chemicals </li></ul></ul></ul><ul><ul><ul><li>Alcoholic Hepatitis : Ethanol and Acetaldehide </li></ul></ul></ul><ul><ul><ul><li>Viral Hepatitis : HAV, HBV, HCV, HDV, HEV </li></ul></ul></ul><ul><ul><ul><li>Autoimmune Hepatitis : diseases that have autoimmune reponses. </li></ul></ul></ul>
  22. 22. Pathophysiology
  23. 23. Etiology Exposure to hepatitis Virus Infection and inflammation of the liver Hepatocyte damage Necrosis of the part of the liver; alteration of liver function Diagram Persistence of the condition/ worsening R.I.P
  24. 24. Nursing Management <ul><li>Risk for infection </li></ul><ul><li>Fatigue </li></ul><ul><li>Imbalance Nutrition </li></ul><ul><li>Disturbed body image </li></ul>