Hepatitis c

Hepatitis C Note compiled

1. Hepatitis C

Anatomy and physiology of liver







Function of liver
 Glucose metabolism.
 Fat metabolism.
 Protein metabolism.
 Vitamin and iron storage.
 Ammonia conversion.
 Detoxification of drugs and toxic substances.
 Synthesis of plasma proteins
 Bile formation.
 Bilirubin excretion.

2. Defination
 Hepatitis C is a systemic viral infection in which inflammation and necrosis of the liver cells occurs.
 It is one of the leading cause of liver inflammation now a days caused by hepatitis C virus (HCV)

Incubation period
 The infection is often asymptomatic. Incubation period may varies from 15 to 160 days.

Senerio of hepatitis C
 Approximately 35,000 new cases of hepatitis C are reported in the United States each year.
 There are 10,000 to 12,000 deaths each year in US due to hepatitis C.
 WHO estimates that there are 130 to 170 million people infected globally.

Hepatitis C virus
 Hepatitis virus is a small, enveloped RNA virus
 There are 7 genotypes of HCV and the genotypes are divided into many subtypes.
 There is no vaccine or immunoglobulin made till now for hepatitis C.

Pathophysiology
• Exposure to hepatitis C virus
• Liver cells are damaged in two ways: by direct action of the virus or by immune response to the virus
• Cell injury results in inflammation and necrosis in the liver.
• With severe inflammation of the liver, cannot conjugate bile which leads to jaundice
• Necrosis in the liver leads to portal hypertention and esophageal varices
• Fibrosis ,chirrhosis and carcinoma of the liver

Risk factors for hepatitis C
 It mainly spreads through parental route.
 Intravenous drug users (IUDs)
 Past/current iv injection drug use
 Blood transfusion infected with HCV
 Organ transplant from a donor who is infected with HCV
 Multiple sex partners, history of sexually transmitted disease, unprotected sex.
 Sharing personal care items such as razors, scissors, nail clippers or a toothbrush with an infected
person.
 Health workers after needle stick injuries or mucosal exposure to boold
 Children born to women infected with hepatitis C virus
 Using non-sterile instruments and needles for tattooing and body piercing.

Clinical manifestations
1. Acute infection: hepatitis c infection causes acute symptoms in 15% of cases. Symptoms are generally
mild which includes:
 Fatigue
 Nausea
 Anorexia
 Weight loss
 Muscle or joint pain
 Jaundice

 The infection may resolve in 10 to 50% of cases.

3. 2. Chronic infection:about 80% of those exposed to the virus develop a chronic infection. Sign and
symptoms includes:
 Fatigue
 Jaundice
 Fatty changes to the liver
 Portal hypertention
 Liver cirrhosis
 Esophageal varices
 Hepatocellular carcinoma

Diagnosing hepatitis C
 History taking.
 Physical examination.
 Anti HCV test: detects the presence of antibodies to the HCV in the blood.

Laboratory diagnosis
LAB TESTS
Pigment tests:
• Serum bilirubin (total)
• Serum bilirubin (direct)

CLINICAL FUNCTIONS
These studies measures the ability of the liver to conjugate and
excrete bilirubin.
Protein studies:
• Total serum protein
• Serum albumin
• Serum globulin
Proteins are manufactured by the liver. Their levels may be affected
in viral hepatitis, chronic hepatitis and other liver impairments.
Prothrombin time Prothrombin time will be prolonged in liver damage.
Transaminase studies:
• AST (SGOT)
• ALT (SGPT)
These enzymes are elevated in liver cell damage.

Serum ammonia Liver converts ammonia to urea. Ammonia level rises in liver
damage.
Ultrasonography To determine size of liver
Liver biopsy To determine anatomic changes in liver tissue.
CT scan To detect hepatic neoplasm; diagnose cysts, abscesses, hematomas and
obstruction.
MRI To detect hepatic neoplasm; diagnose cysts, abscesses, hematomas and
obstruction.
Endoscopy To search for esophageal varices and other abnormalities.

4. Treatment
 Combination of two antivirus agents, interferon (intron-A) and ribavirin (rebetal) is effecting in
producing improvement in patient with HCV.
 Liver transplant if liver is damaged completely.

Complications
Life threatening esophageal and gastric varices
Cirrhosis of the liver
Liver failure
Carcinoma of the liver

Nursing management
o Assessment: assess:
 Activity
o Weakness
o Fatigue
o Malaise
 Elimination
o Dark urine
o Diarrhoea
 Food and fluids
o Anorexia
o Weight loss
o Nausea and vomiting
o Increased edema
o Ascitis
 Neuro-sensory
o Lethargy
 Pain
o Abdominal cramps
o Liver tenderness
o Splenomegaly
o Itching (pruritis)

NURSING DIAGNOSIS:
 Fatigue related to decreased metabolic energy production secondary to liver dysfunction.
 Imbalanced nutrition: less than body requirement related to anorexia, nausea, bile stasis and altered
absorption and metabolism.
 Anxiety related to uncertainty of the effects of hepatitis.
 Impaired skin integrity related to pruritus.

Nursing management
 Encourage for ADLs.
 Teach to avoid alcohol.
 Provide vitamin supplements as ordered.
 Relieve nausea and vomiting.
 Explain about the disease and its management to relieve anxiety and worries.
 Provide psycological support to the patient and family members
 Teach the patient to take adequate rest
 Maintain high calorie and low fat diet
 Manage pain by using ordered analgesics

5.  Maintain cleanliness without causing dry skin
 Advise not to scratch the skin to prevent from further infection

Prevention
At present, no vaccine exist to prevent infection with HCV, therefore its important to avoid exposure
to the virus.
Screening of the blood should be done before transfusions
Blood transfusion should be given only when absolutely necessary
Public health awareness programs should be conducted on shared needles in iv or injection drug use.
Avoid multiple sexual partners and use condoms for prevention.
Use universal precautions for every patient while working in hospitals and other health care facility.
Do not share toothbrush, razor or anythingelse that might have blood on it or contaminated with the
person having HCV
If you want to get tattoo or have your body pierced, make sure the practioner sterilize the instrument and
supplies
Call your doctor if you have symptoms of hepatitis or if you think you may have been exposed to
someone who has it.