Download HEPATITIS B and c VIRUS (HBV) File

HEPATITIS B and c
VIRUS (HBV)
Hepatitis
Definition and cause: Hepatitis is an
inflammation of the liver which is caused by
viral hepatitis, resulting from six major viruses
A, B, C, D, E, and G.
HEPATITIS B VIRUS (HBV)
hepatitis B is transmitted primarily through blood.
HBV has been found in blood, saliva, semen, and vaginal
secretions and can be transmitted through mucous
membranes and breaks in the skin. HBV is also
transferred from carrier mothers to their babies
Hepatitis B virus: Transmission is through
Mothers infected with HBV
Unsafe injections and transfusions
Sexual activity (homosexuals and hetrosexuals)
Pathophysiology of hepatitis
The pathophysiologic changes in the various
types of viral hepatitis are similar. During
acute infection, liver damage is mediated by
cytotoxic cytokines and natural killer cells that
cause lysis of infected liver cells. Liver
damage results from hepatic cell necrosis.
With time, liver cells can regenerate, and in
absence of complications, they should restore
their normal appearance and function.
Risk Factors for Hepatitis B
• Frequent exposure to blood, blood products, or
other body fluids
• Health care workers
• Hemodialysis
• Male homosexual
• IV/injection drug use
• Close contact with carrier of HBV
• Travel to or residence in area with uncertain
sanitary conditions
• Multiple sexual partners
• Recent history of sexually transmitted
disease(SITD)
• Receipt of blood or blood products (eg, clotting
factor concentrate)
Clinical Manifestations
Signs and symptoms of hepatitis B may be
insidious and variable:
Fever and respiratory symptoms are rare
some patients have arthralgias and rashes.
loss of appetite,
dyspepsia,
abdominal pain,
generalized aching,
malaise, and weakness.
Jaundice may or may not be evident. If
jaundice occurs, light-colored stools and
dark urine accompany it.
The liver may be tender and enlarged to 12
to 14 cm vertically. The spleen is enlarged
and palpable. in a few patients; the
posterior cervical lymph nodes may also
be enlarged.
Assessment and Diagnostic
Findings
HBV is a DNA virus composed of the following
antigenic particles:
• HBcAg—hepatitis B core antigen (antigenic
material in an inner core)
• HBsAg—hepatitis B surface antigen (antigenic
material on surface of HBV)
Each antigen elicits its specific antibody and
is a marker for different stages of the
disease process:
• anti-HBc—antibody to core antigen or
HBV; persists during the acute phase of
illness; may indicate continuing HBV in the
liver
• anti-HBs—antibody to surface
determinants on HBV; detected during late
convalescence; usually indicates recovery
and development of immunity
Bilirubin (serum and urinary): ↑
Prothrombine time: Prolonged.
Serum proteins: Normal or ↑
Prevention
The goals of prevention are to interrupt the
chain of transmission, to protect people at
high risk with active immunization through
the use of hepatitis B vaccine, and to use
passive immunization for unprotected
people exposed to HBV.
PREVENTING TRANSMISSION
Continued screening of blood donors for the
presence of hepatitis B antigens will
further decrease the risk of transmission
by blood transfusion.
ACTIVE IMMUNIZATION:
HEPATITIS B VACCINE
Active immunization is recommended for:
1)individuals at high risk for hepatitis B (eg,
health care personnel and hemodialysis
patients).
2)individuals with hepatitis C and other
chronic liver diseases should receive the
vaccine
Medical Management
The goals of treatment are to minimize infectivity,
normalize liver inflammation, and decrease symptoms.
1. Of all the agents that have been used to treat chronic
type B viral hepatitis, alpha interferon as the single
modality of therapy offers the most promise.
2. Two antiviral agents (lamivudine [Epvir] and adefovir
[Hepsera]) have been approved for use in chronic
hepatitis B.
3.Bed rest may be recommended, regardless of other
treatment, until the symptoms of hepatitis have
subsided
4. Adequate nutrition should be maintained;
proteins are restricted when the liver’s ability to
protein by products is impaired
metabolize
Avoid alcohol and drugs detoxified by the liver
↑ calorie,↑ carbohydrates, vitamins, and ↓fat
Nursing Management
Convalescence may be prolonged, with complete symptomatic
recovery sometimes requiring 3 to 4 months or longer. During
this stage, gradual resumption of physical activity is
encouraged after the jaundice has resolved.
The nurse identifies psychosocial issues and concerns,
particularly the effects of separation from family and friends
if the patient is hospitalized during the acute and infective
stages.
.
 Even
if not hospitalized, the patient will be
unable to work and must avoid sexual
contact.
 Planning is required to minimize
alterations in sensory perception.
 Planning that includes the family helps to
decrease their fears and anxieties about
the spread of the disease
HEPATITIS C VIRUS (HCV)
Hepatitis C virus: Transmission is through
.Contaminated needles
.Blood transfusion
.Sexual activity
HCV is the underlying cause of about one-third of cases
of hepatocellular carcinoma, and it is the most common
reason for liver transplantation
Risk Factors for Hepatitis C
• Recipient of blood products or organ transplant
• Health care and public safety workers after needlestick
injuries or mucosal exposure to blood
• Children born to women infected with hepatitis C virus
• IV/injection drug use
• Past treatment with chronic hemodialysis
• Sex with infected partner, having multiple sex partners,
history of STD, unprotected sex
Collaborative care for viral hepatitis
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There is no specific treatment for acute viral hepatitis.
Patients can be managed at home. Rest and wellbalanced diet may be the most beneficial for liver cell
regeneration and healing.
In chronic hepatitis B & C, follow the above mentioned
instructions and administer prescribed medications (αinterferon & lamivudine, ribavirin).
Observe side affects of α-interferon (arthralgia, myalgia,
fatigue, headache, fever, nausea, anorexia) and ribavirin
(anemia, anorexia, cough, dyspnea, insomnia, bruritus).