Viral Hepatitis Flashcards
1
Q
the liver
A
the liver serves several functions
*blood storage, blood filtration, production of bilirubin, synthesis of clotting factors, removal of clotting factors
*metabolism of carbs, fat, and protein
*detoxifies blood
*storage area for vit. A, D, E, and K and iron
hepa- = liver, -itis = inflammation
2
Q
hepatitis
A
- epidemiology: viral hepatitis, alcoholic and toxic hepatitis, 2 types of autoimmune hepatitis
- pathophysiology: inflammation of liver cells most commonly caused by a virus that impairs the liver’s ability to function normally
3
Q
meds that can cause hepatitis
A
- statins
- anabolic steroids
- azathioprine
- methotrexate
- isoniazid
- valproic acid
- tetracyclines
- phenytoin
- acetaminophen
4
Q
hepatitis A & E
A
fecal-oral route
5
Q
hepatitis B, C, & D
A
blood and bodily fluid route
- blood, serum, plasma
- amniotic, pleural, peritoneal, pericardial, synovial, and CSF
- semen and vaginal fluids
6
Q
acute vs chronic
A
- acute hepatitis infection lasts less than 6 months > most clients shed the virus and recover from all their symptoms
- chronic hepatitis lasts longer than 6 months and can span the client’s lifetime > chronic hepatitis increases the client’s risk for cirrhosis and liver cancer
7
Q
clinical manifestations
A
- may present with flu-like symptoms
- abd pain, irritability, pruritus, fatigue, malaise, fever, nausea, vomiting, jaundice
- lab abnormalities: elevated liver enzymes > aspartate aminotransferase (AST), alanine transaminase/alanine aminotransferase (ALT); elevated bilirubin (total and direct); elevated serum ammonia; decreased albumin; other enzyme tests: gamma-glutanyl transferase (GGT); alkaline phosphate; lactate dehydrogenase (LDH)
- dark urine
- clay colored stool
8
Q
manifestations of hepatitis
A
acute
*anorexia
*clay-colored stool
*dark urine
*decreased sense of taste and smell
*diarrhea or constipation
*fatigue, lethargy, malaise
*flu-like symptoms
*hepatomegaly
*jaundice
*low-grade fever
*lymphadenopathy
*myalgias and/or arthralgias
*nausea, vomiting
*pruritus
*right upper quadrant tenderness
*splenomegaly
*weight loss
chronic
*ALT, AST elevations
*ascites and lower extremity edema
*asterixis ("liver flap")
*bleeding abnormalities
*fatigue, malaise
*hepatic encephalopathy: confusion, difficulty concentrating, easy agitation
*hepatomegaly
*increased bilirubin
*jaundice
*myalgias and/or arthralgias
*palmar erythema
*spider angiomas
*symptoms can me mild or severe: most severe is fulminant hepatitis/fulminant hepatic failure = rapidly progressive, life-threatening form of acute liver failure that includes: neurological decline (encephalopathy), GI bleeding, coagulation disorders, thrombocytopenia, fever, edema, ascites
9
Q
hepatitis A
A
- incubation: 15-50 days (average 28)
- fecal-oral (primarily fecal contamination and oral ingestion)
- sources of infection: contaminated food; crowded conditions (day care, nursing home); persons with subclinical infections, infected food handlers, sexual contact, IV drug users; poor personal hygiene; poor sanitation
- infectivity: most infectious during 2 wk before onset of symptoms; infectious until 1-2 wk after start of symptoms
10
Q
hepatitis B
A
- incubation: 115-180 days (average 56-96)
- sources of infection: contaminated needles, syringes, blood products; HBV-infected mother (perinatal); sexual activity with infected partners; tattoos or body piercing with contaminated needles
- infectivity: before and after symptoms appear; infectious for months; carriers continue to be infectious for life
11
Q
hepatitis C
A
- incubation: 14-180 days (average 56)
- sources of infection: blood and blood products; needles and syringes; sexual activity with infected partners, low risk
- infectivity: 1-2 wk before symptoms appear; continues during clinical course; 75-85% go on to develop chronic hepatitis C and remain infectious
- HCV is considered “cured” of the virus is not detected in your blood when measured with a blood test 3 months after treatment is completed; called a sustained virologic response (SVR) and data suggest that you will stay virus free indefinitely
12
Q
hepatitis D
A
incubation: 2-26 wk
* HBV must precede HDV
* chronic carriers of HBV always at risk
* sources of infection: same as HBV; can cause infection only when HBV is present
* infectivity: blood infectious at all stages of HDV infection
13
Q
hepatitis E
A
- incubation: 15-64 days (average 26-42)
- fecal-oral
- outbreaks associated with contaminated water supply in developing countries
- sources of infection: contaminated water, poor sanitation; found in Asia, Africa, Mexico; non common in US but increasing in some areas
- infectivity: not known, may be similar to HAV
14
Q
hepatitis management
A
- medical management: lab and diagnostic testing includes assessments that determine the extent of liver damage; FibroScan or liver biopsy
- meds: oral antiviral agents, pegylated interferon injections, and vaccinations for hepatitis A and B
- surgical management: liver transplantation > cadaver ot living donor
15
Q
nursing assessments and actions
A
- VS
- assessment, especially skin and sclera color
- daily weight
- monitor intake and output
- promote balance between physical activity and rest
- administer meds
- administer antiemetics
- provide small, frequent meals and supplements
