Hepatitis (viral and non viral types) ppt slideshare

Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), poor appetite, vomiting, tiredness, abdominal pain, and diarrhea. Hepatitis is acute if it resolves within six months, and chronic if it lasts longer than six months.

1. HEPATITIS Presented by: Sonam Yadav 11-06-2021 1

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6. HEPATITIS Hepatitis is defined as the inflammation of the liver. According to WHO, 325 million people globally live with a hepatitis infection. Viral hepatitis B infection in the world is among 257 million people. Hepatitis C infection is among 71 million people globally. 11-06-2021 6

7. . Nearly 96,000 people die annually in India due to Hepatitis C, which has become a hidden epidemic according to WHO report. India has an estimated number of 40 million chronic Hepatitis B Virus (HBV) infected people throughout the country, constituting about 11 percent of the estimated global Hepatitis-B burden. The prevalence rate of Chronic Hepatitis B Virus (HBV) infection in India is  around 3 to 4 percent . The prevalence of HCV infection in India is  1 per cent. Men are more prone as compared to women. EPIDEMIOLOGY 11-06-2021 7

8. Types Of Hepatitis (Based On Duration) ACUTE HEPATITIS Duration more than 6 months Duration less than 6 months CHRONIC HEPATITIS 11-06-2021 8

9. TYPES OF HEPATITIS (cause based) VIRAL HEPATITIS NON VIRAL HEPATITIS Drug Induced Hepatitis Toxic Hepatitis OTHER TYPES 11-06-2021 9 Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Autoimmune Hepatitis Alcoholic Hepatitis Non Alcoholic Steatohepatitis (NASH)

10. Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E VIRAL HEPATITIS Hepatitis G 11-06-2021 10

11. 11-06-2021 11 HEPATITIS A HEPATITIS B HEPATITIS C HEPATITIS E TYPE OF VIRUS RNA DNA RNA RNA ROUTE OF TRANSMISSION Feaco -oral route Parenteral Parenteral Feaco -oral route SEVERITY OF ILLNESS Mild Severe Mild Mild CHRONICITY OF DISEASE None 10% 50-60% None

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13. . Formerly as Infectious hepatitis. Accounts for 20-25% of cases of clinical hepatitis. Hepatitis A Causative organism: Hepatitis A virus Incubation period: 15- 50 days (average: 28 days) Mode of transmission: Fecal oral route 11-06-2021 13

14. 11-06-2021 14 Etiological factors Invasion of virus into liver cells and replication Cytotoxic cytokines and NK cells release to attack virus Lysis of infected hepatocytes Scar tissue forms around dead and infected liver cells Liver damage and improper function cirrhosis Reduces blood flow to the liver Permanent Shrinking and hardening of liver Chronic infection Dormant and reactivation PATHOPHYSIOLOGY

15. 11-06-2021 15 1. Prodromal Symptoms

16. 11-06-2021 16 Icteric Phase 2. Icteric Phase

17. 11-06-2021 17 3. Convalescent Phase

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19. Assessment and Diagnostic findings The liver and spleen are often moderately enlarged for a few days after onset; otherwise, apart from jaundice , there are few physical signs. Hepatitis A antigen may be found in the stool a week to 10 days before illness and for 2 to 3 weeks after symptoms appear. HAV antibodies are detectable in the serum, but usually not until symptoms appear: done through ELISA. Biochemical test may reveal abnormal levels of bilirubin, alanine aminotransferase, and protein. Blood tests: 2 kind of antibodies – IgM (shows acute infection) and IgG (previous infection). 11-06-2021 19

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21. T wo-dose vaccine be given to adults 18 years of age or older, with the second dose 6 to 12 months after the first. PREVENTION Children and adolescents 2 to 18 years of age receive three doses, with the second dose 1 month after the first and the third dose 6 to 12 months later. Vaccination : Havrix & Vaqta 11-06-2021 21

22. Travelers to developing countries S ettings with poor or uncertain sanitation conditions Recommended for: O ther high-risk groups (homosexual men, injection/intravenous drug users, staff of day care centers, and health care personnel). Immune globulin : for household members and sexual contacts of people with hep. A, Day care center and restaurant workers with exposure to or infected with hepatitis A 11-06-2021 22

23. Good personal hygiene and proper sanitation Twinrix ( combined Hep. A and B vaccine ) is available for vaccination of people 18 years of age and older with indications for hep. A and B vaccination. (3 doses-0,1,6 months) 11-06-2021 23

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25. Medical Management S upportive treatment Bed rest during the acute stage. During the period of anorexia, the patient should receive frequent small feedings, supplemented , if necessary, by IV fluids with glucose. Optimal food and fluid levels are necessary to counteract weight loss and slow recovery. Gradual but progressive ambulation seems to hasten recovery, provided the patient rests after activity and does not participate in activities to the point of fatigue. 11-06-2021 25

26. Nursing Management A ssist the patient and family in coping with the temporary disability and fatigue that are common in hepatitis. S pecific guidelines about diet, rest, follow-up blood work . The importance of avoiding alcohol. Sanitation and hygiene measures (particularly hand washing) to prevent spread of the disease. 11-06-2021 26

27. . Hepatitis B Causative organism: Hepatitis B virus Incubation period: 6 0-150 days (average 90 days) Mode of transmission: percutaneous and per mucosal routes 11-06-2021 27

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31. Assessment And Diagnostic Finding Hepatitis B virus is a DNA virus composed of the following antigenic particles: HBcAg - hepatitis B core antigen HBsAg - hepatitis B surface antigen (antigenic material on the viral surface, a marker of active replication and infection) HBeAg - an independent protein circulating in the blood. HBxAg - gene product of X gene of HBV DNA 11-06-2021 31

32. . Anti-HBc-antibody , persists during the active phase of illness, may indicated continuing HBV in the liver. Anti-HBs-antibody , detected during late convalescence, usually indicates recovery and development of immunity. Anti- HBe -antibody , signifies reduced infectivity. Anti- HBxAg -antibody , may indicate ongoing replication of HBV. HBsAg appears in the circulation in 80-90% of infected patients 1 to 10 weeks after exposure to HBV and 2 to 8 weeks before the onset of symptoms or an increase in transferase levels. L iver ultrasound or transient elastography can show the amount of liver damage. liver biopsy , and fibro tests 11-06-2021 32

33. 11-06-2021 33 Prevention

34. . A yeast-recombinant hepatitis B vaccine is used to provide active immunity and has shown rates of protection greater than 90% in healthy people Active Immunization N urses and health care professionals exposed to blood and blood products Al l unvaccinated people being evaluated for a STI, history of STI, people with multiple sex partners, people who have sex with IV or injection drug users, or sexually active men with other men. 11-06-2021 34

35. Passive Immunity: Hepatitis B Immune Globulin Hepatitis B immune globulin (HBIG) provides passive immunity to hepatitis B and is indicated for people exposed to HBV who have never had hepatitis B and have never received hepatitis B vaccine. Specific indications for postexposure vaccine with HBIG include: (1) Inadvertent exposure to HBAg -positive blood through percutaneous (needlestick) or transmucosal (splashes in contact with mucous membrane) routes (2) sexual contact with people positive for HBAg (3) Perinatal exposure. 11-06-2021 35

36. Medical Management Treatment of acute hepatitis B is indicated only in patients with severe hepatitis and liver failure. Nucleoside and nucleotide analog such as tenofovir, adenofovir , lamivudine. Interferon : standard interferon (intron A), pegylated interferon ( peglntron ): Alpha interferon as the single modality of therapy: regimen of 5 million units daily or 10 million units three times weekly for 4 to 6 months. Liver transplant 11-06-2021 36

37. Dietary management Recommend small, frequent meal s, minimize periods without food intake. Provide intake of 25-30 kcal/day. Provide protein intake of 1-1.5 g/kg/day . Carefully monitor fluid balance. Be aware that that enteral feedings may be necessary if anorexia, nausea, and vomiting persist. Instruct patient to abstain from alcohol during acute illness and for at least 6 months after recovery. Advise patients to avoid substances (medications, herbs, illicit drugs, and toxins) that may affect liver function. 11-06-2021 37

38. 11-06-2021 38 Types of hepatitis on the basis of duration? Types of hepatitis on the basis of cause? Name of the vaccine for hepatitis A prevention? Stages of symptoms development in hepatitis? What are the four antigenic particles of hepatitis B DNA virus? Dose, route and frequency of hepatitis B vaccine? Route of transmission for hepatitis A and hepatitis C?

39. Hepatitis C Incubation period: 14-182 days (average: 14-84 days) Mode of transmission: Direct percutaneous or mucous membrane exposure Causative organism Hepatitis C virus Non-A, No n-B hepatitis, or NANB hepatitis 11-06-2021 39

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41. Assessment and diagnostic findings HCV antibody: ELISA: It takes at least 4 weeks after infection before antibody appears. HCV-RNA: PCR is done to diagnose HCV infection in acute phase, however its main use is in monitoring the response to antiviral therapy. Liver ultrasound Biochemical studies 11-06-2021 41

42. Management: Combination of two antiviral agents, peginterferon and ribavirin ( Rebetol ) , is effective in producing improvement in patients with Hepatitis C and in treating relapse. Peginterferon ( pegasys ) Ribavirin must be used cautiously in women of childbearing age . The triple therapy of protease inhibitor, peginterferon, and ribavirin is recommended as standard of treatment for Hepatitis C by American Association for the study of liver disease. 11-06-2021 42

43. Prevention Advise avoidance of high-risk behaviors such as IV drug use. Use needless IV and injection systems in health care Use barrier precautions in situation of contact with blood or body fluids. Monitor cleaning, disinfection and sterilization of reusable devices in patient care settings. Avoid multidose vials in patient care settings. Use standard precautions in clinical care. 11-06-2021 43

44. Hepatitis D The virus requires hepatitis B surface antigen for its replication, only individuals with hepatitis B are at risk for hepatitis D. Incubation period: 21-140 days Causative organism Hepatitis D virus Mode of transmission: Same as hepatitis B 11-06-2021 44 Coinfection & superinfection

45. . Diagnosis Anti-delta antibodies on testing confirm the diagnosis. Sexual contact with those having hepatitis B is considered to be an important mode of transmission B and D. Management Treatment is similar to that of other forms of hepatitis . Interferon alpha is the only licensed drug for the treatment of hepatitis D. 11-06-2021 45

46. Hepatitis E Incubation period: 15 to 65 days Causative organism Hepatitis E virus Mode of transmission: Fecal oral route 11-06-2021 46 Resembles Hepatitis A Jaundice is nearly always present Diagnosis: Anti HEV IgM and Ig G HEV RNA quantification

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48. 11-06-2021 48 Hepatitis G or GB virus-C NA NB NC Hepatitis Incubation period: 14 to 145 days Causative organism Hepatitis G virus & GB virus-C Strong significance in HIV coinfection. Mode of transmission: Parenteral or sexual

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51. NON VIRAL HEPATITIS . 11-06-2021 51

52. C arbon tetrachloride, Vinyl chloride, Herbicides, phosphorus, chloroform, gold compounds, and Industrial chemicals known as polychlorinated biphenyls. Toxic hepatitis resembles viral hepatitis in onset. Obtaining a history of exposure to hepatotoxic chemicals, medications, or other agents assists in early treatment and removal of the offending agent. TOXIC HEPATITIS 11-06-2021 52

53. . Symptoms: Anorexia, nausea, and vomiting, jaundice and hepatomegaly. Symptoms are more intense for the more severely toxic patient. Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There are no effective antidotes . Vomiting may be persistent , with the emesis containing blood . Clotting abnormalities may be severe, and hemorrhages may appear under the skin . Delirium, coma, and seizures develop , and within a few days the patient may die of fulminant hepatic failure. Therapy is directed toward restoring and maintaining fluid and electrolyte balance, blood replacement, and comfort and supportive measures. 11-06-2021 53

54. . A cetaminophen, I soniazid, H alothane, C ertain antibiotics, A ntimetabolites, M edications used to treat rheumatic and musculoskeletal disease, A ntidepressants, psychotropic medications, anticonvulsants, and Inhalational agents of the halothane family are metabolized by the liver and excreted in bile. These volatile anaesthetics may also decrease hepatic blood flow. Halothane hepatitis is a dreaded but rare complication of halothane administration I soflurane is considered the anaesthetic agent of choice in patients with liver disease. DRUG INDUCED HEPATITIS 11-06-2021 54 More than 900 drugs, toxins and herbs

55. . Risk factors: Females Old Age Alcoholic or Liver disease Comorbidities such as AIDS, TB, ARF, DM, etc. Symptoms: Usually the onset is abrupt, with chills, fever, rash, pruritus, arthralgia, anorexia, and nausea . Later, there may be jaundice and dark urine and an enlarged and tender liver. When the offending medication is withdrawn, symptoms may gradually subside. However, reactions may be severe and even fatal, even though the medication is stopped. If fever, rash, or pruritus occurs from any medication, its use should be stopped immediately. A short course of high-dose corticosteroids may be used in patients with severe hypersensitivity. Liver transplantation 11-06-2021 55

56. AUTOIMMUNE HEPATITIS . It is a chronic inflammation of the liver of unknown cause Majority of patients are women. It is characterized by the presence of autoantibodies. There is an autoimmune reaction against normal hepatocytes. Type 1 and type 2 are the two types of autoimmune hepatitis. D iagnosis : serological markers such as antinuclear antibodies, anti-DNA antibodies . Treatment: Prednisone, and azathioprine Patient who does not respond to prednisone and azathioprine, cyclosporine, budesonide, methotrexate are used. 11-06-2021 56

57. . Alcoholic hepatitis is a disease, inflammatory condition of the liver caused by heavy alcohol consumption over an extended period of time. Diagnosis: CBC, LFT, USG, CT scan, blood clotting test, liver biopsy. Treatment: Patients needs to stop drinking. ALCOHOLIC HEPATITIS 11-06-2021 57

58. . It is a part of non-alcoholic fatty liver disease (NAFLD) It is a condition where fat builds up in the liver not due to alcohol consumption. It is the inflammation and liver cell damage along with fat in liver. It is a serious condition that results in cirrhosis, hepatocellular cancer, liver failure. Risk factors Obesity DM HTN Hyperlipidemia NON ALCOHOLIC STEATOHEPATITIS (NASH) 11-06-2021 58

59. . Clinical findings Elevated liver enzymes, Liver biopsy, liver scan, CT scan, and USG. Treatment : There is no definitive treatment and therapy is directed at reduction of risk factors Treat diabetes, weight reduction and management of hyperlipidemia. 11-06-2021 59

60. PREVENTION

61. Complications Fibrosis Liver cancer Hepatitis coinfection Fulminant hepatitis Liver cirrhosis Hepatic encephalopathy Kidney related problems 11-06-2021 61

62. Nursing assessment Assess for systemic and liver related symptoms Obtain history such as IV 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 . 11-06-2021 62

63. 1. Imbalanced nutrition less than body requirements related to the effects of liver dysfunction 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 antiemetics as prescribed. Encourage eating meals in a sitting position to decrease pressure on the liver. 11-06-2021 63

64. 2. Deficient fluid volume related to nausea and vomiting Monitor intake and output Provide frequent oral fluids as tolerated. Administer IV fluids for patients with inability to maintain oral fluids 11-06-2021 64

65. 3. Activity intolerance related to anorexia and liver dysfunction 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 administering analgesics and prescribed. 11-06-2021 65

66. 4. risk for injury related to coagulopathy because of impaired liver function M onitor and teach patient to monitor and report sign of bleeding Monitor PT and administer Vitamin K as ordered. Avoid trauma that may cause bruising. 11-06-2021 66

67. 5. Risk of disease transmission related to unhygienic practices 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 11-06-2021 67

68. 6. Disturbed thought process related to complication such as hepatic encephalopathy Monitor for signs of encephalopathy Monitor for worsening of condition from stupor to coma Maintain calm, quite environment and reorient patient as needed. 11-06-2021 68

69. . 11-06-2021 69 SUMMARY

70. . As discussed throughout the presentation, hepatitis is defined as the inflammation of liver. Hepatitis can be further classified as viral and non-viral hepatitis. Viral hepatitis includes hepatitis A, B, C, D, E and G and non-viral hepatitis that are caused due to medications include toxic hepatitis and drug induced hepatitis. Nurses can also counsel the patients and their family for various options available in treatment for hepatitis. 11-06-2021 70 CONCLUSION

71. . Brunner & Suddarth’s . Textbook of Medical Surgical. 13 th edition Volume-2. New Delhi: Wolters Kluwer;2015; Page no. 1349-1353 Lewis’s. Textbook of Medical-Surgical Nursing.11 th EditionVolum 2. Chintamani Mani;2010 Joyce M. Black and Jane Hokanson ; medical surgical nursing; volume 2, 8 th edition, reed Elsevier, India pvt. [Internet]. Cdc.gov. 2021 [cited 11 April 2021]. Available from: https://www.cdc.gov/hepatitis/resources/professionals/pdfs/abctable.pdf Hepatitis [Internet]. Slideshare.net. 2021 [cited 11 April 2021]. Available from: https://www.slideshare.net/NikhilVaishnav3/hepatitis-128140979 Hepatitis - Wikipedia [Internet]. En.wikipedia.org. 2021 [cited 11 April 2021]. Available from: https://en.wikipedia.org/wiki/Hepatitis Hepatitis: Types, Symptoms, and Treatment [Internet]. Healthline. 2021 [cited 11 April 2021]. Available from: https://www.healthline.com/health/hepatitis#treatment 11-06-2021 72 References

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