Hepatitis Flashcards
What is hepatitis?
Inflammation of the liver
What can cause hepatitis?
Viral (Most common) Alcohol Medications Chemicals Autoimmune diseases Metabolic problems
What is an acute infection of the liver?
- Large numbers of hepatocytes are destroyed.
- Liver cells can regenerate in normal form after resolution of infection.
What can a chronic hepatic infection cause?
Fibrosis and progresses to cirrhosis.
What are systemic manifestations of hepatitis?
Rash Angioedema Arthritis Fever Malaise Cryoglobulinemia Glomerulonephritis Vasculitis
What is Hep A?
- Ranges from mild to acute liver failure
- Not chronic
- Incidence decreased with vaccination
- RNA virus transmitted via fecal-oral route
How is Hep A transmitted?
Contaminated food or drinking water.
What is Hep B?
- Acute or chronic disease
- Incidence decreased with vaccination
- DNA virus
How is Hep B transmitted?
- Perinatally
- Percutaneously
- Via small cuts on mucosal surfaces and exposure to infectious blood, blood products, or other bodily fluids.
What is Hep C?
- Acute: asymptomatic
- Chronic: Liver damage
- RNA virus transmitted percutaneously
What are risk factors for Hep C?
- IV drug use
- High risk sexual behavior
- Occupational exposure
- Perinatal exposure
- Blood transfusion before 1992
Who is most at risk for Hep B?
- Men who have sex with men
- Household contact of chronically infected
- Patients on hemodialysis
- Health care and public safety workers
- IV drug users
- Recipients of blood products
What is the acute phase of Hep B?
- Physical examination findings Hepatomegaly Lymphadenopathy Splenomegaly - Icteric (Jaundice) or anticteric
What makes a patient icteric (jaundice)?
Too much bilirubin
What are signs of icteric (jaundice)?
- Dark urine
- Light or clay-colored stools
- Pruritus
What is the convalescent phase of Hep B?
- Begins as jaundice is disappearing
- Lasts weeks to months
- Major problems
Malaise
Easy fatigue - Hepatomegaly persists
- Splenomegaly subsides
What diagnostic studies can we do for Hepatitis?
- Specific antigen and/or antibody for each type of viral hepatitis.
- Liver function tests
- Viral genotype testing
- Physical assessment findings
- Liver biopsy
- FibroScan
- FiberoSure (FibroTest)
How do we care for a patient with Hepatitis?
- Assess for jaundice
- Comfort measures
- Adequate nutrition
How do we make sure patients have adequate nutrition?
- Small, frequent meals
- Measures to stimulate appetite
- Carbonated beverages
- Adequate fluid intake
How do we manage acute and chronic hepatitis?
- Adequate nutrition
- Rest
- Avoid alcohol and hepatotoxic drugs
- Notification of possible contacts
- Psychological and emotional rest
- Diversion activities
Nutritional therapy for Hepatitis?
- No special diet needed.
- Vitamins B-complex and K
- IV glucose or enteral nutrition
Pharmacological therapy for acute hepatitis?
- Acute HAV infection: no specific
- Acute HBV infection: Only if severe
- Acute HCV infection: DAAs (Directing acting antiviral)
What supportive drugs can we give for acute hepatitis?
- Antihistamines
- Antiemetics
What medicine can we give for chronic Hep B and C?
- Interferon
- Pegylated interferon
- Flu-like side effects, and depression
What are risk factors for cirrhosis?
- Male
- Alcohol use
- Concomitant fatty liver disease
- Excess iron deposition in the liver
What are risk factors for chronic Hepatitis?
- Chronic HBV is more likely to develop in under age 5.
- HC infection is more likely than HBV to become chronic.
- <50% of immunocompromised adults that are acutely infected with HBV progress to chronic.
