HEAPATITIS A, B,C OUTLINE: A. HEPATITIS- inflammation liver due to drugs, chemicals, VIRUS, or autoimmune dx. B. MOST COMMON: A.

HEP A: 1. Fecal oral route 2. Flue like symptoms, most infectious 2wks prior onset symptoms & 1-2wks after start 3. Life-long immunity, No carrier state,vaccine 4. Transmission between those living close contact, institutionalized people, day care, ingestion contaminated water and shellfish. 5. Anti-HAV IgM= dx acute infection, anti-HAV IgG= previous infection B. HEP B: 1. Transmission: Blood, drug abuse, sexual contact, mother to fetus 2. Lives on dry surfaces for 7dys 3. Life-long immunity, Carrier state, presence HBsAG 6-12mths, vaccine 4. Infectious prior to and after symptoms, lasts 4-6mths 5. HBsAG=current infection, HBcAG=on going infection, HBeAB=high infectivity 6. Anti-HBcIgM=acute infection, anti-HBcIgG=previous infection, antHBe=previous infection C. HEP C: 1. Transmission: same as per hep B 2. Infection puts @ risk hepatocellular carcinoma 3. Can be re-infected w/ other strains hep C 4. Infectious 1-2wks prior symptoms and during clinical course 5. Anti-HCV= acute/chronic infection, enzyme immunoblot assay (EIA)= screening for HCV D. ETIOLOGY 1. Drugs, chemicals, VIRUS, autoimmune dx causes inflammation & necrosis of hepatic cells, enlargement & proliferation Kupfer cells, inflammation periportal areasbile stasis 2. Antigen-antibody complex activates complement system causing fever, angioedema, arthritis, malaise 3. Bilirubin diffuses into tissues, bile salts accumulate, hepatomegaly & splenomegaly occur. E. JAUNDICE-yellow discolouration & tissues 1. Hemolytic- due to overactive & enlarged spleen breaking down RBCs 2. Hepatocellular- liver cant conjugate or excrete bilirubin 3. Obstructive- obstructed bile flow

F. S/S HEPATITIS: 1. Anorexia 2. Weight loss 3. N&V, diarrhea 4. Jaundice 5. Uticaria 6. Puritis 7. Dark urine 8. Clay coloured stools 9. Increased liver enzymes & bilirubin 10. Bilirubinurea 11. cirrhosis

12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

Fever fatigue Lethargy Myalgia Arthralgia Decreased sense of smell and taste Hepatomegaly Splenomegaly Headache ROQ pain

G. LABS & DIAGNOSTICS: 1. Hepatitis serologic markers: hep A-C, EIA 2. Liver fxn tests: I. Increased AST, ALT (decrease as jaundice disappears)& alkaline phosphatase II. Increased serum total serum bilirubin & PTT III. N/decreased albumin levels 3. Liver biopsy (chronic hep only...gold standard extent injury & prognosis hep C) H. COMPLICATIONS 1. Cirrhosis- HBV, HCV 2. Chronic hepatitis 3. Filament hepatic failure- liver cells fail to regeneratesevere impairment & necrosis cellsliver failure tx=liver transplant 4. Liver failure I. Frequent mental IV. i/o status checks V. oral & skin care II. Minimize VI. hemodynamic environmental monitoring: stimuli glucose, e-lytes, III. Bed rails & acid base padding VII. HOB 30 degrees I. COLLABORATIVE CARE: 1. REST- alt. Periods rest and activity 2. DIET THERAPY I. High calorie, high protein, high carb, low fat II. Avoid alcohol intake & drugs detox. By liver 3. DRUG THERAPY I. Vitamin supps II. antiemetics III. HEP B: pegylated interferon & nucleoside analogs ex. Lamvudine (Epivir) IV. HEP C: pegylated interferon & ribavirin

4. SURGERY: Liver transplant for those end-stage liver dx due to chronic hepatitis

J. NURSING MANAGEMENT: 1. HEALTH PROMOTION I. VACCINATION a. HAV & IG (IG gives passive immunity those exposed, lasts 12mths), single dose IM w/ booster 6-12mths later b. HBV- 3 shots IM 0,1,6mths c. HAV & HBV (Twinrix) 3 shots IM 0,1,6mths ENSURE ADEQUATE NUTRITION a. Sm frequent high cal, car, protein meals b. Measures stimulate appetite ex. Oral care, antiemetics, carbonated drinks c. Avoid hot/cold beverages, adequate fluids (2500-3000mL) REST

2. ACUTE INTERVENTION I.

II.