UNDERSTANDING HEPATITIS : TREATMENT AND PREVENTIVE MEASURES

HEPATITIS

Hepatitis is the inflammation of the liver characterized by jaundice and tenderness. It may be caused by viruses, medications and toxic agents. It is classified as viral and non-viral hepatitis

FORMS OF HEPATITIS

There are at least five forms of hepatitis; A, B, C, D and E. F and G have also been discovered but they do not cause health threat that is they are not known to cause any problem

HEPATITIS B

A viral infection caused by the hepatitis B virus (HBV), an enveloped DNA virus that infects the liver and causes hepatocellular necrosis and inflammation. HBV infection can be either acute or chronic and may range from asymptomatic infection or mild disease to severe or rarely fulminant hepatitis

ACUTE HEPATITIS

Acute hepatitis B is usually a self-limiting disease marked by acute inflammation and hepatocellular necrosis.

CHRONIC HEPATITIS

Chronic hepatitis B (CHB) infection encompasses a spectrum of disease and is defined as persistent HBV infection (the presence of detectable hepatitis B surface antigen (HBsAg) in the blood or serum for longer than six months), with or without associated active viral replication and evidence of hepatocellular injury and inflammation

Causative organism:

It is caused by the Hepatitis B virus, a hepatotropic virus, which belongs to the hepadnavirus family

HBV has been found in blood, saliva, semen, and vaginal secretions and can be transmitted through mucous membranes and breaks in the skin.

MODE OF TRANSMISSION

• Injection given with syringes and or needles contaminated by body fluids of infected person Sexual intercourse with infected person
• Kissing and biting by infected persons may spread it since the virus is present in saliva
• Transfusion with infected blood and blood products
• Carrier mothers can transmit to their infants during the birth process
• Indirectly from exudates from the skin ulcers and tears of infected persons
• Sweat and tears of infected persons have also been found to contain the virus
• Using of contaminated sharps such as razors, piercing tools

RISK FACTORS FOR HEPATITIS B

• Homosexuals
• Sexually active persons
• Health care workers
• Parenteral drug users
• Patients on dialysis
• Ear piercing and tattooing
• Patients who undergo multiple blood transfusion
• Children born to infected mothers
• Recipients of solid organ transplant
• Male homosexual and bisexual activity
• IV/injection drug users
• Close contact with carriers of HBV
• Travelers who have not completed the Hep B vaccination series visiting endemic areas
• People with Multiple sexual partners
• Recent history of sexually transmitted disease
• Receipt of blood or blood products (eg, clotting factor concentrate).

INCIDENCE

Most people (90%) who contract hepatitis B infections develop antibodies and recover spontaneously in 6 months

The mortality rate from hepatitis B has been reported to be as high as 10%

Another 10% of patients who have hepatitis B progress to a carrier state or develop chronic hepatitis with persistent HBV infection and hepatocellular injury and inflammation

It remains a major cause of cirrhosis and hepatocellular carcinoma worldwide.

CLINICAL MANIFESTATIONS

Initial features are of non-specific flu-like symptoms common to almost all acute viral infections. These symptoms appear within 1-3weeks of contact with the infection.

• Malaise
• Mild Fever
• Nausea and vomiting
• Muscular and joint aches
• Diarrhea/ constipation
• Headache
• Slight abdominal pain in the right upper quadrant
• Loss of appetite
• Indigestion
• Intolerance to odor such as cigarette smoke

LATER SYMPTOMS 6-8 WEEKS

• Profound loss of appetite
• Dark urine
• Jaundice
• Pale colored stool containing pus
• Dizziness
• Itching
• Spontaneous bleeding
• Anemia due to decrease lifespan of RBC
• Drowsiness

DIAGNOSTIC INVESTIGATION

Serum bilirubin (>2.5mg/dl)

AST (Asparte aminotransferase rise to 1000-2000mu/ml)

Liver function test  
Liver biopsy for histology 

Abdominal x-ray

Certain serologic markers e.g. Hep A/GM

Full blood count Medical Management Goals for medical management treatment: to minimize infectivity, normalize liver inflammation, and decrease symptoms. There is no specific treatment for acute hepatitis B therefore cares is aimed at maintaining comfort and adequate nutritional balance including replacement of fluids lost through nausea and vomiting. Chronic Hep B

1. Oral Antiviral Agents: Eg Tenofovir, enteacavir

2. Interferon alpha injections (inhibits viral growth)

3. Anti-emetic: Example IV metoclopramide 10mg single dose then PRN

4. Antacids: Example Oral magnesium hydroxide

5. Diuretics: example Laxis 40mg daily

NURSING MANAGEMENT

• Patient is isolated and the importance of isolation explained to the patient and family
• All soiled linens and articles used by patient are disinfected
• A conducive environment is provided to enhance rest and sleep
• Nurse the patient in a well-ventilated room
• Serve prescribed antipyretics such as paracetamol
• Serve cold drinks
• Remove all nauseating articles from patient’s bedside
• Serve patient with low spicy diet to help prevent aggravation of diarrhea
• Administer prescribed IV fluids and also transfuse blood

PREVENTION AND CONTROL

• Avoid unnecessary sexual exposure
• Use condom for casual sexual intercourse if it cannot be avoided
• Encourage abstinence until marriage and partners should be faithful to each other to reduce the risk of being infected
• Visit qualified institutions for health care to prevent contaminated articles being used on them
• Sharps and piercing instruments should be sterilized before and after use
• Blood should be well screened before used for transfusion
• Infected mothers should be given antiretroviral therapy to minimize the risk of infecting the children during delivery
• All children should be given active immunization against the disease with pentavalent vaccine
• Promiscuous behavior should be discouraged
• Discouraged indiscriminate kissing to avoid exchange of saliva to prevent infection
• Some persons become life-long carriers and so must be educated to prevent infecting others 

COMPLICATIONS

• Cirrhosis of the liver
• Liver cancer
• Liver failure
• Hepatic coma
• Hepatic encephalopathy
• Hepatocellular carcinoma

REFERENCE

Medicine and Medical Nursing (Revised Edition) by R. Boakye-Yiadom

Nurses’ Dictionary (25th Edition) Edited by Barbara F. Weller

Www.nhs.uk/Condition/genital-herpes  www.Medscape.com