HEPATITIS.pptx gasto intestinal, communicable nursing material

medical surgical nursing

1. HEPATITIS

2. 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.

3. However , in global terms, viral infections are the most important cause of hepatitis. These include infections with herpes simplex virus, cytomegalovirus and Epstein–Barr virus, but the majority of viral liver diseases are by hepatitis viruses. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A , Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E.

4. RISK F AC T OR S

5. ETIOLOGY OF HEPATITIS

6. DARK URINE Abdominal discomfort Right upper abdominal pain Jaundice Fever Nausea Anorexia Diaherrea Fatigue Hepatomegalin Elevated level of bilirubin

7. VIRAL HE PA TIT I S

8. 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.

9. Hepatitis A (formerly known as “infectious” hepatitis) is an acute infectious disease caused by Hepatitis A virus (HAV). The disease is heralded by non-specific symptoms such as fever, chills, headache, fatigue, generalized weakness and aches and pains, followed by anorexia, nausea, vomiting, dark urine and jaundice. The disease is benign with complete recovery in several weeks.

10. Agent factors AGENT: The causative agent, the hepatitis A virus, is an enterovirus of the Picornaviridae family. It multiplies only in hepatocytes. RESISTANCE: The virus is fairly resistant to heat and chemicals. . RNA Naked RNA virus

11. RESERVOIR OF INFECTION: The human cases are the only reservoir of infection. INFECTIVE MATERIAL : Mainly man’s faeces. Host factors AGE: Infection with HAV is more frequent among children than in adults. However, people from all ages may be infected if susceptible. SEX: Both sexes are equally susceptible .

12. Incubation period 10-50 days (usually 25 to 30 days ) Mode of Transmission FA E CA L - OR A L R O U T E: -By contaminated water, food P A R E NTE R AL R O U T E (Rare l y): -By blood and blood products or by skin penetration through contaminated needles. SEX UAL T R A N SMISSI O N:

13. Sources of infection:- Crowded conditions, poor personal hygiene, Poor sanitation, Contaminated food, water, shellfish, person with subclinical infections, infected food handlers.

14. PHYSICAL EXAMINATION Icteric sclera,skin and secretions Mild weight loss of 2-5kg Hepatomegaly. LABORATORY EXAMINATION Demonstration of Virus in feaces, blood, bile: By: Immunoelectron microscopy Detection of Antibody :By ELISA Biochemical tests: Alanine aminotransferase (ALT) Bilirubin

15. MANAGEMENT There are no drug therapies for the treatment of acute hepatitis A. 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 . Corticosteroid given in patients with acute HAV when cholestic or fulminant hepatic failure is evident.

16. Prevention:- -hygienic measures and sanitation -Immunoglobulin to prevent Hepatitis A Immunoglobin provides protection against HAV by passive transfer of conc antibodies against HAV.Ig is effective.preganancy and lactation are not contraindications to receiving Ig.Given iv and im. -vaccines Given as a 2-dose series,6 mnths apart. A vaccine is useful in preventing secondary infection. Treatment: - nospecific, dietary food and long rest

17. HEPATITIS B (Hep B)

18. Hepatitis B (formerly known as “serum” hepatitis) is an acute systemic infection with major pathology in the liver, caused by hepatitis B virus. The acute illness causes liver inflammation, vomiting,jaundice, and, rarely, death. Chronic hepatitis B may eventually cause cirrhosis and liver cancer.

19. Epidemiology Determinants Agent factor AGENT: Hepatitis B Virus (HBV) -It replicates in liver cell. RESERVOIR OF INFECTION: -Men is the only reservoir of infection which can be spread either from carriers or from cases. Infective material: -Contaminated blood is the main source, -Virus has been found in body secretion such as saliva, vaginal secretion & Semen in infected material.

20. Mode of transmission Parentral route Perinatal transmission-spread of infection from HBV carrier mother to their babies.HBV can infect the foetus in utero.This rarely occur at birth,as result of leak of maternal blood into baby’s circulation. Sexual transmission.

21. SYMPTOMS OF HEPATITIS B

22. Serology Liver Chemistry tests AST, ALT, ALP, and total Bilirubin Histology--Immunoperoxidase staining Liver Biopsy--to determine grade(Inflammation) and stage(Fibrosis) in chronic Hepatitis

23. Prevention 🞂 🞂 Vaccination - highly effective recombinant vaccines H e p a t i t i s B I mmunog l obulin ( HB I G) -exposed within 48 hours of the incident/ neonates whose mothers are HBsAg and HBeAg positive. Other measures -screening of blood donors, blood and body fluid precautions.

24. National Immunization Schedule Vaccine Wh en t o Do se Give Route Site Hepatitis At birth or 0.5 ml IM Antero B as soon as lateral possible side of with in 24 mid thigh hours. Hepatitis At 6, 10, 0.5 ml IM Antero B 1,2,3 14 weeks lateral side of mid thigh

25. TREATMENT FOR HEPATITIS B Interferon :- Alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system the antiviral drugs :- lamivudine, adefovir,, entecavir . Nucleoside and Nucleotide analog such as Tenofovir, adenofovir, lamivudine . Liver transplant.

26. Hepatitis C Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years.

27. Incubation Period 40-120 days Mode of Transmission Intravenous Drug Use Healthcare Exposure: Blood Transfusion, transfusion of Blood products, Organ Transplant without HCV screening carry significant risk of infection. Hemodialysis Accidental injuries with needles/sharps Multiple sex partners Vertical Transmission: Vertical transmission of hepatitis C from an infected mother to her child.

28. Diagnosis HCV antibody – ELISA used to diagnose hepatitis C infection. Not useful in the acute phase as it takes at least 4 weeks after infection before antibody appears. HCV-RNA - various techniques are available e.g. PCR and branched DNA. May be used to diagnose HCV infection in the acute phase. However, its main use is in monitoring the response to antiviral therapy. HCV-antigen - It is used in the same capacity as HCV-RNA tests but is much easier to carry out.

29. Prevention Only General Prophylaxis, such as blood, tissue, organ screening, is possible. No specific active or passive immunizing agent is available . Treatment Interferon - may be considered for patients with chronic active hepatitis. Ribavirin - combination of interferon and ribavirin is more effective than interferon alone.

30. Hepatitis D Hepatitis D , also referred to as hepatitis D v i r us ( H D V ) an d classifie d a s Hep a ti t i s delt a vi r u s , is a disease caused by a small circular enveloped RNA virus. HDV infection develops only in patients who are positive for hepatitis B surface antigen. Incubation Period 2-12weeks Mode of Transmission The primary route of Transmission are believed to be similar to those of HBV, It can be transmitted sexually..perinatal transmission is rare.

31. SYMPTOMS OF HEPATITIS D

32. Diagnosis Delta antigen is primarily expressed in liver cell nuclei, where it can be demonstrated by immunofluorescence. Anti-delta antibodies appear in serum and can be identified by ELISA. IgM antibody appears 2-3 weeks after infection and is soon replaced by the IgG antibody in acute delta infection. TREATMENT Interferon Lamivudine Adefovir

33. Prevention HBV-HDV Coinfection Pre or post exposure prophylaxis to prevent HBV infection. Screening of blood donor for HBsAg. HBV-HDV Superinfection Education to reduce risk behaviors among persons with chronic HBV infection.

34. Hepatitis E Hepatitis E is a viral hepatitis (liver inflammation) caused by infection with a virus called hepatitis E virus ( HEV ). Although Hepatitis E often causes an acute and self-limiting infection) with low mortality rates. In pregnant women the disease is more often severe and is associated with a clinical syndrome called fulminant hepatic failure. MODE OF TRANSMISSION Faecal-oral route Contaminated food and water Person-person is rare but maternal-neonatal transmission occur Zoonotic spread may occur.

35. SYMPTOMS OF HEPATITIS E

36. Diagnosis ELISA kits are available for IgG and IgM antibodies, using recombinant and synthetic peptide antigens. Prevention Sanitation: Avoid drinking water of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler. No vaccine currently available. TREATMENT No specific treatment Only supportive measures are required.

37. Hepatitis G GB virus C ( GBV-C ), formerly known as hepatitis G virus ( HGV ) and also known as HPgV is a virus in the Flaviviridae family and a member of the Pegivirus genus, is known to infect humans, but is not known to cause human disease. HGV RNA has been found in patients with acute, chronic and fulminant hepatitis, hemophiliacs, patients with multiple transfusions and hemodialysis, intravenous drug addicts and blood donors.

38. 34