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NUR 201 Week 11 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Is inflammation of the liver ?

Causes
> Viral (most common)
> Alcohol
> Rx’s
> Chemicals
> Autoimmune dz’s
> Metabolic abnormalities

A

Hepatitis

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2
Q

Types of viral hepatitis
> A, B, C, D, E

Differ in modes of transmission & clinical manifestations

A
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3
Q

Hepatitis ___

  • Ranges from mild to acute liver failure
  • Not chronic
  • Incidence dec w/vaccination
  • RNA virus transmitted via fecal-oral route
  • Contaminated food or drinking water
A

A (HAV)

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4
Q

Serology - HAV

  • Virus is present in feces during incubation period, so it can be carried & transmitted by persons who have undetectable, subclinical infections
  • Greatest risk of transmission occurs <clinical sx’s appear
A
  • HAV is found in feces 2 wks or more before the onset of sx’s & up to 1 wk >the onset of jaundice; present only briefly in blood
  • Anti-HAV (antibody to HAV) immunoglobulin M (IgM) appears in the serum as the stool becomes negative for the virus
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5
Q
  • Detection of hepatitis A IgM indicates acute hepatitis
  • Hepatitis A IgG indicates past infection; IgG antibody provides lifelong immunity
A
  • Hep A vaccination & thorough handwashing are the best measures to prevent outbreaks
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6
Q

Hepatitis ___

  • Acute or chronic dz [hepatitis]
  • Incidence dec w/vaccination
  • DNA virus transmitted
    1. perinatally
    2. percutaneously
    3. via small cuts on mucosal surfaces & exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva)
  • No evidence that urine, feces (w/o GI bleeding), breast milk, tears, & sweat are infective
A

B (HBV)

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7
Q
  • At-risk populations
    > Men who have sex w/men
    > Household contact of chronically infected
    > Pts undergoing hemodialysis
    > Healthcare & public safety workers
    > Organ & tissue transplant recipients
A
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8
Q

Serology - HBV

  • HBV is a complex structure w/3 distinct antigens
  • surface antigen (HBsAg)
  • core antigen (HBcAg)
  • e antigen (HBeAg)
A
  • Each antigen along w/its corresponding antibody may appear or disappear in serum depending on the phase of infection & immune response
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9
Q
  • Screening for HBV usually includes identifying those @ risk for infection & testing the blood for the presence of HBsAg, hepatitis B surface antibody (anti-HBs), & hepatitis B core antibody (anti-HBc)
A
  • The presence of anti-HBs in the blood indicates immunity from the HBV vaccine or from past infection
  • Detection of HBsAg in the serum for 6 mos or longer >infection indicates chronic HBV infection
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10
Q

Hepatitis ___

  • Acute: symptomatic
  • Chronic: liver damage
  • RNA virus transmitted percutaneously
    > IV drug use
    > High-risk sexual behaviors
    > Occupational exposure
    > Dialysis
    > Perinatal exposure (co-infection w/HIV)
    > Blood transfusions <1992
A

C (HCV)

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11
Q

The most common causes of acute hepatitis C outbreaks are among injection drug users & HIV-positive MSM

A

Chronic HCV is the most common cause of chronic liver dz & liver failure (20-30% infected pts develop cirrhosis & eventually liver failure &/or cancer)

! Also @ risk for HBV & HIV infections

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12
Q

Hepatitis ___

  • Also called delta virus
  • Defective single-stranded RNA virus
  • Cannot survive on its own
  • Transmitted percutaneously
  • NO vaccine
  • An asymptomatic chronic carrier state to acute liver failure
A

D (HDV)

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13
Q

Hepatitis D virus requires hepatitis ___ to replicate

A

B

> Can be acquired @ the same time as HBV, or a person w/HBV can be infected w/HDV @ a later time

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14
Q

Hepatitis ___

  • RNA virus
  • Transmitted via fecal-oral route
  • Most common mode of transmission: drinking contaminated water
  • Occurs primarily in developing countries
  • Few cases in US
A

E (HEV)

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15
Q

Pathophysiology

  • Acute infection
    > Large #’s of hepatocytes are destroyed
  • bile production, coagulation, blood glucose, & protein catabolism can be affected as well as detoxification of rx’s, hormones, & metabolites
    > Liver cells can regenerate in normal form >resolution of infection
  • Chronic infection can cause fibrosis & progress to cirrhosis (& liver failure)
A
  • Antigen-antibody complexes activate complement system
  • Clinical manifestations are rash, angioedema, arthritis, fever, & malaise
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16
Q

____ (abnormal proteins found in the blood), glomerulonephritis, & vasculitis can occur 2° to immune complex activation

A

Cryoglobulinemia

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17
Q

Clinical Manifestations

  • Classified as acute & chronic
  • Many pts: asymptomatic
  • Sx’s intermittent or ongoing
    > Malaise
    > Fatigue
    > Myalgias/arthralgias
    > RUQ tenderness (c/b liver inflammation)
A
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18
Q

The ___ phase is the period of maximal infectivity
> usually lasts from 1-4 mos

A

acute

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19
Q

During the ___ period, sx’s may include
- anorexia, lethargy, wt loss
- fatigue, N/V, RUQ tenderness
- distaste for cigarettes, dec sense of smell
- low-grade fever, skin rashes
- myalgias, arthralgias

A

incubation

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20
Q

Acute phase - physical exam findings
- hepatomegaly
- lymphadenopathy
- abd tenderness
- splenomegaly

  • Icteric (jaundice) or anicteric
A
  • If icteric, pt can also have
    > dark urine
    > light or clay-colored stools
    > pruritus
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21
Q

___, a yellowish discoloration of body tissues, results from an alteration in normal bilirubin metabolism or flow of bile into the hepatic or biliary duct systems

  • urine may darken b/c excess bilirubin being excreted by the kidneys
A

Jaundice

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22
Q

If conjugated bilirubin cannot flow out of the liver b/c obstruction or inflammation of the bile duct, stools will be light or clay-colored

A

Pruritus (intense chronic itching) sometimes accompanies jaundice
> Occurs as a result of the accumulation of bile salts beneath the skin

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23
Q

The ___ phase following the acute phase begins as jaundice disappears & lasts for wks to mos, w/an avg of 2-4 mos

Major complaints - malaise & easy fatigability

Hepatomegaly remains but splenomegaly subsides

A

convalescent

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24
Q

Recovery

  • Most pts recover completely w/no complications
  • Most cases of Hep A resolve
  • Some HBV & majority of HCV result in chronic hepatitis
A

Complications

! Acute liver failure
! Chronic hepatitis (some HBV & majority of HCV infections)
! Cirrhosis
! Portal HTN
! Hepatocellular carcinoma

25
Q

Acute liver failure

  • Fulminant hepatic failure
  • encephalopathy, GI bleeding, DIC, fever w/leukocytosis, oliguria, azotemia, ascites, edema, hypotension, resp failure, hypoglycemia, bacterial infections, thrombocytopenia, coagulopathies
  • Liver transplant is usually the cure
A
26
Q

Chronic hepatitis

  • Chronic HBV is more likely to develop in infants & those <5
  • HCV infection is more likely than HBV to become chronic
A
  • Manifestations incl anemia & coagulation problems (easy bruising, bleeding), as well as skin manifestations (spider angiomas, palmar erythema, gynecomastia)
27
Q

Cirrhosis - (risk factors incl)

  • Male gender
  • Alcohol consumption
  • Concomitant fatty liver dz
  • Excess iron deposition in liver
  • Pts w/metabolic syndrome
A
28
Q

___ ___

  • a potentially life-threatening spectrum of neurologic, psychiatric, & motor disturbances
  • results from liver’s inability to remove toxins (esp ammonia from the blood)
A

Hepatic encephalopathy

29
Q

___

  • accumulation of excess fluid in peritoneal cavity
  • d/t reduced protein lvls in blood which reduces the plasma oncotic pressure
A

Ascites

30
Q

Diagnostic Studies

! Specific antigen &/or antibody for each type of viral hepatitis

A
31
Q

Hepatitis A

Anti-HAV ___ indicates previous infection or immunization

Anti-HAV ___ indicates acute infection

A

IgG

IgM

32
Q

Hepatitis ___

Currently, no serologic tests to diag infection are commercially avail in the US

Diagnostic tests are avail in research labs

A

E

33
Q

Hepatitis C

Anti-HCV (antibody to hepatitis C) is a marker for acute or chronic infection w/HCV

A

HCV RNA quantitation indicates active, ongoing viral replication

34
Q

Hepatitis D

Anti-HDV (antibody to hepatitis D) is present in past or current infection w/hepatitis D

A

HDV Ag (hepatitis D antigen) is present within a few days after infection

35
Q

Hepatitis B

HBsAg
anti-HBs
HBeAg
anti-Hbe
anti-Hbc IgM
anti-Hbc IgG
HBV DNA quantitation

Which of these is the best indicator of viral replication & effectiveness of therapy in pts w/chronic HBV infection?

A

HBV DNA quantitation

36
Q

?

Indicates high infectivity & is used to determine the clinical management of pts w/chronic HBV infection

A

HBeAg (hepatitis B e antigen)

37
Q

?

Is a marker of infectivity; present in acute or chronic infection & in chronic carriers

A

HBsAg (hepatitis B surface antigen)

38
Q

?

Indicates prev infection w/hepatitis B or immunization

A

Anti-HBs (hepatitis B surface antibody)

39
Q

?

Indicates previous infection

A

Anti-HBe [hepatitis B e antibody]

40
Q

?

Indicates acute infection & does not appear after vaccination
> does not appear after vaccination

A

Anti-HBc IgM (antibody to hepatitis B core antigen)

41
Q

?

Indicates previous infection or ongoing infection w/hepatitis B
> also does not appear after vaccination

A

Anti-HBc IgG

42
Q

LFT’s

AST, ALT, GGT, alkaline phosphatase lvls are all elevated

γ-globulin normal or inc

albumin normal or dec

A

Serum total bilirubin & urinary bilirubin inc

urinary urobilinogen inc 2-5d <jaundice appears

PT prolonged

43
Q

Viral genotype infection (HBV, HCV)

  • 8 genotypes of HBV
  • 6 genotypes & >50 subtypes of HCV
    ! HCV genotype 1 = 75% of HCV infections
A

Physical assessment
☄ hepatic tenderness
☄ hepatomegaly
☄ splenomegaly
- Liver is palpable

> Liver biopsy
FibroScan (ultrasound elastography)
FibroSure [FibroTest] (a biomarker)

44
Q

Interprofessional Care - Acute & chronic

  • Adequate nutrition
    > Well-balanced diet (calories; fat content)
    > Vitamin supplements (B-complex, K)
  • IV glucose solutions; supplemental enteral nutrition
  • Rest (° & strictness varies)
A
  • Avoid alcohol intake & drugs detoxified by liver
  • Notification of possible contacts
45
Q

Drug Therapy

Acute HAV infection: no specific

Acute HBV infection: only if severe hepatitis & liver failure

A

Acute HCV infection: pegylated interferon or direct-acting antivirals (DAAs) within 1st 12-24 wks of infection dec development of chronic hep C

46
Q

Supportive rx therapy

⋆ Antihistamines - for generalized itching
☉ Antiemetics - for nausea

A

☉ prochlorperazine (Compazine)

⋆ ☉ promethazine (Phenergan)

☉ ondansetron (Zofran)

47
Q

Interprofessional Care - Chronic Hepatitis B

To ↓ viral load, liver enzyme lvls, & rate of dz progression

Prevent cirrhosis, portal HTN, liver failure, & hepatocellular cancer

A

1st line therapies now incl primarily nucleoside (NS) & nucleotide (NT) analogs & occ interferon therapy
> NS & NT analogs don’t prevent all viral reproduction, but can substantially lower the amt of virus in the body

48
Q

lamivudine (Epivir)
adefovir (Hepsera)
entecavir (Baraclude)
telbuvidine (Tyzeka)
tenofovir (Viread)

oral rx’s are indicated in treatment of chronic HBV when there’s evidence of significant active viral replication & liver inflammation

A
49
Q

?

  • Is a naturally occurring immune protein
  • Antiviral, antiproliferative, & immune-modulating effects
  • Pegylated ? given subcutaneous
  • Blood counts, LFT’s q4-6 wks
  • S/e: flu-like sx’s [fever, malaise, fatigue], depression(!)
A

Interferon

Pegylated interferon (PegIntron, Pegasys)

50
Q

Nutritional Therapy

  • No special diet required
    > Emphasis on well-balanced diet that pt can tolerate
    > Adequate calories are important during acute phase
    > Fat content may need to be reduced
A
  • Vitamins B-complex & K
  • IV glucose or enteral nutrition
51
Q

Nursing Assessment: Subjective Data

A

Nursing Assessment: Objective Data

  • Low-grade fever
  • Jaundice, lymphadenopathy
  • Rash, icteric sclera
  • Hepatomegaly
  • Splenomegaly
  • Abn lab values
52
Q

Nursing Diagnoses: Viral Hepatitis

  • Imbalanced nutrition: less than body requirements r/t anorexia & nausea
  • Activity intolerance r/t fatigue & weakness
  • Risk for impaired liver function r/t viral infection
A

Planning

Patient will
1. Have relief of discomfort
2. Be able to resume normal activities
3. Return to normal liver function w/o complications

53
Q

___, ___, & ___:

primary immunization consists of a single dose administered IM in the deltoid muscle; a booster is recommended 6-12 mos >the primary dose to ensure adequate antibody titers & long-term protection

A

Havrix, Vaqta, Avaxim

54
Q

Recombivax HB & Engerix-B contain HBsAg that promotes the synthesis of specific antibodies directed against HBV

A

For post-exposure prophylaxis, the HBV vaccine & hepatitis B immune globulin (HBIG) are used; HBIG should be given within 24 hrs of exposure & start the vax series

55
Q

Health Promotion: Hepatitis C

  • No vaccine to prevent HCV
  • General measures to prevent transmission
    1. screening of blood, organ, & tissue donors
    2. use of infection control precautions
    3. modifying high-risk behavior
A
  • screen all persons born between 1945-1965
  • no post-exposure prophylaxis; baseline & f/u testing
56
Q

In light-skinned persons, jaundice is usually observed first in the sclera of the eyes & later in the skin

A

In dark-skinned persons, jaundice is observed in the hard palate of the mouth & inner canthus of the eyes

57
Q

! Bleeding tendencies w/inc PT
! Manifestations of encephalopathy
! Sudden inc in wt & abd girth (may be d/t fluid retention &/or ascites)
! Bloody or tarry stools, vomiting of blood, elevated LFT’s

A
58
Q

Evaluation - Expected Outcomes

✓ Maintain food & fluid intake adequate to meet nutritional needs
✓ Avoid alcohol & other hepatotoxic agents
✓ Demonstrate gradual increase in activity tolerance

A

✓ Perform daily activities with scheduled rest periods
✓Ability to explain methods of transmission & methods of preventing transmission

NUR 201 Week 11 (5 decks)

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