Hepatitis -Pathophysiology, Podcast, and Nursing Care Plan

hepatitis

Hepatitis

Hepatitis is caused by viruses, exposure to certain medications, alcohol/substance abuse, and even bacteria that attack the liver.  Acute hepatitis lasts less than 6 months. Chronic hepatitis can eventually cause cirrhosis, liver cancer, and liver failure.

The most common types of hepatitis are hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E.

The main goal of treatment for hepatitis is to rest the inflamed liver, decrease the metabolic demands, and increase the blood supply to prevent further injury and promote cellular regeneration.

Before we discuss hepatitis further, lets’ review the function of the liver. The liver is located in the upper right hand side of the abdomen under the rib cage. Blood is carried from the intestines to the liver. This blood from the intestines encompasses almost everything that is absorbed in the intestines which includes toxins and nutrients.

As the liver breaks down the toxins in the blood, it excretes them as harmless waste products into the bile or back into the blood stream. Bile enters the intestine and will then exit the body in feces. If the byproducts are excreted by the liver back into the blood supply, they are then filtered out by the kidneys and leave the body via urine. The liver also breaks down and metabolizes alcohol and drugs making them inert and also excreting them out of the body. If the lever is damaged, all these toxins will build up in the body.

Aside from getting rid of toxins, the liver is also responsible for making physiological products for the body to function: Clotting factors, bile, and cholesterol.  It is also responsible for storing fats, sugars and vitamins for the body to use later. Sugar gets stored in the liver in the form of glycogen where it is then released into the blood as needed.

hepatitis

Stages of Viral Hepatitis

  1. Preicteric – The first stage of hepatitis. Flu like symptoms: fatigue, nausea, vomiting, diarrhea, muscle aches.  Serum bilirubin and enzyme levels are elevated.
  2. Icteric – The second stage. Jaundice, pruritis, dark tea colored urine, clay colored stools.
  3. Post-icteric – the convalescent stage of hepatitis. Jaundice starts to go away. Urine and stool start to return to normal.

 

Types of Hepatitis

Type of HepatitisMode of TransmissionPrevention
Type of HepatitisMode of TransmissionPrevention
Hepatitis A (HAV)Fecal / Oral Contaminated food or waterHand washing HAV vaccine
Hepatitis B (HBV)Infected blood, sex, and needles Infected mother to newborn Hand washing HBV vaccine
Hepatitis C (HCV)Infected blood and needlesHand washing NO Vaccine
Hepatitis D (HDV)Must also have Hepatitis B Infected blood, sex, and needles Infected mother to newbornHand washing HBV vaccine
Hepatitis E (HEV)Contaminated waterHand washing NO Vaccine

 

Hepatitis A Virus:

Cause:

The hepatitis A virus is transmitted through the fecal-oral route. When a person ingests any amount of contaminated fecal matter,  they can develop HAV. The hepatitis A virus causes inflammation by infecting liver cells.

 

Hepatitis A virus can be transmitted:

 

  • Eating food handled by someone who doesn’t wash his or her hands after using the toilet.
  • Having a close contact with a person who is infected. Even if that person has no signs or symptoms.
  • Sexual relationship with someone who has the virus.
  • Drinking contaminated water.

 

 

Sign and symptoms:

HAV occurs mainly in children and young adults. The incubation period is: 10-15 days.

The typical signs are:

  • Fever
  • Anorexia
  • Nausea
  • Vomiting

The other signs include:

  • Clay-colored stools
  • Loss of appetite
  • Dark urine
  • Joint pain

 

Complications:

Hepatitis A does not cause long-term liver damage like other viruses.

But in some rare cases, hepatitis A can cause loss of liver function. This occurs suddenly in older adults or people with chronic liver diseases.

 

Diagnosis:

The diagnosis methods of HAV are:

  • Detection of IgM antibody by ELISA.
  • Test for abnormal liver function, such as serum ALT and bilirubin.
  • Demonstration of HAV particles or specific viral antigens in the feces, bile and blood.

 

Treatment:

 

There are no treatments for the disease. There is vaccine available for hepatitis A.

Active immunization- Vaccine containing inactivated HAV is used.

Once the patient recovers from Hepatitis A, they are immune for life.

 

Hepatitis B Virus:

Liver disease due to HBV is an enormous global health problem. One third of the worlds population has been infected with HBV, and 400 million people have chronic infection. Cause: Hepatitis B is a blood borne disease. It is transmitted through blood and blood products, sexual route and perinatally from mother to newborn.

Causes of transmission:

  • Contaminated syringes and needles.

 

  • Semen, which contain small amounts of blood, and saliva that is connected with virus.

 

 

  • Men or women who have multiple sex partners and do not use a condom.

 

 

  • Unprotected heterosexual or homosexual intercourse and intravenous drug abuse may cause the HBV.

 

 

  • People who receive transfusions of blood or blood products.

 

 

  • People with other sexually transmitted diseases.

 

 

  • Tattooing with infected needles.

 

 

  • Infants born to infected mothers.

 

 

  • Inadvertent needle sticks experienced by healthcare workers.

 

 

Sign and Symptoms: The sign and symptoms of HBV are same as that of hepatitis A. But the symptoms may be more serious and life-threatening hepatitis can occur. Some of the symptoms are:

  • Nausea and vomiting

 

  • Tiredness

 

 

  • Loss of appetite

 

 

  • Abdominal pain

 

 

  • Muscle and joint pain

 

 

  • Jaundice (yellowish eyes and skin, dark urine and pale-colored feces/poo).

 

 

  Complications:

  • Liver failure

 

  • Chronic hepatitis

 

 

  • Cirrhosis of liver

 

 

  • Liver cancer

 

 

  • Aplastic anaemia

 

 

  • Post hepatitis syndrome

 

 

  • Papular acrodermatitis

 

 

  • Connective tissue disease

 

 

  Diagnosis:

    • Blood tests (Elisa and LFT’s)

 

Treatment: Antiviral medications Rest

Hepatitis C Virus:

Hepatitis C virus is a major cause of liver disease worldwide, with approximately 170 million people affected.

Cause:

  • Blood Transmission.

 

  • Contaminated syringes and needles (especially among injection drug users).

 

 

  • Needle stick injury.

 

 

  • Sexual transmission.

 

 

  • From mother to child (Parenteral through placenta, during delivery in birth canal, post-natal).

 

 

Sign and symptoms:   Acute Hepatitis C: In case of 70%–80% of people with acute Hepatitis C do not have any signs and symptoms. Some patients may have the following symptoms:

  • Fever

 

  • Fatigue

 

 

  • Dark urine

 

 

  • Clay-colored bowel movements

 

 

  • Loss of appetite

 

 

  • Nausea

 

 

  • Vomiting

 

 

  • Abdominal pain

 

 

  • Joint pain

 

 

  • Jaundice (yellow color in the skin or eyes)

 

 

These symptoms occur within 6–7 weeks after exposure of hepatitis C. But this can range from 2 weeks to 6 months. Patients with hepatitis C can spread the virus without showing any symptoms. Many patients do not have symptoms,  they do not look or feel sick.   Chronic Hepatitis C: With chronic Hepatitis C, patients may not have any symptoms.  In many cases, the symptoms of the disease have not been dignosed until liver problems have developed.

Complications:

  • Chronic hepatitis

 

  • Cirrhosis of liver

 

 

  • Fulminant hepatitis ( rare )

 

 

  • Liver cancer

 

 

  • Death

 

 

Treatment: Combination of alpha interferon and ribavirin is used to treat HCV.

Hepatitis D Virus:

HDV has no independent existence. It requires hepatitis B virus for replication and thus causes infection only in presence of HBV.

Cause: It is transmitted via blood, sexually and perinatally.

Sign and symptoms: Hepatitis D virus infection can occur only in a patient who is infected with HBV. Co-infection means infected with both HDV and HBV at the same time.

Treatment: Alpha interferon can be used to mitigate the effects of chronic hepatitis. There is no vaccine against HDV, but patients immunized against HBV will not be infected by HDV since HDV can not replicate in absence of HBV infection.

Hepatitis E Virus:

Hepatitis E does not lead to a chronic infection.   Cause:

  • Major cause of enterically transmitted hepatitis.

 

  • Water or food supply.

 

 

  • Contaminated feces.

 

 

Sign and symptoms: Hepatitis E virus occurs in epidemic form of developing countries. Clinical features resemble that of hepatitis A infection. High mortality rate in pregnant women.

Treatment: There is antiretroviral treatment.

Prevention:

  • Hand washing before eating and after toilet.

 

  • Sanitary disposal of excretions

 

 

  • Purification of community water supplies.

 

 

Nursing Care Plan

Nursing Diagnosis

1. Imbalanced Nutrition: Less than body requirements related to malabsorption.

Desired outcomes:

Within 24 hours of hospital discharge, the client is able to demonstrate progress towards adequate nutritional status as evidenced by progressive weight gain.

InterventionsRationals
InterventionsRationals
Weigh patient daily. Assess and record (I&O) intake and output.To assess adequacy of diet and measure the use of diuretic therapy if utilized.
Allow client to eat that are permitted within dietary meal plan. Explain dietary meal plan and restrictions.Sodium and fluids are restricted due to fluid retention and ascites.
Offer small and frequent meals.If ascites is present, the patient may not be able to tolerate larger meals.

2. Excess Fluid Volume: Risk for electrolyte imbalance related to compromised regulatory mechanisms with accumulation of fluid retention occurring with hepatocellular failure and portal hypertension.

Desired outcomes:

Within 1 day of discharge, client will exhibit normovolemic status as evidenced by respiratory rate between 12 -20 breaths per minute without any respiratory distress, edema at 1 or less,  and a reduction of abdominal girth.

InterventionsRationals
InterventionsRationals
Weigh patient daily. Assess and record (I&O) intake and output.To assess adequacy of diet and measure the use of diuretic therapy if utilized.
Measure abdominal girth for baseline point if reference.This will allow a comparison to observe if there is an increase or decrease in ascites. This will measure the effectiveness of medical treatments.
Assess level of edema from 1 - 4 and document findings.Edema allows health care provider assess if there is an excess on sodium intake or low serum albumin. Ascites is usually associated with low albumin levels.
Monitor vital signs q shiftThis will assess if there is any pulmonary congestion if there is a drop in resp rate. An increase in blood pressure can be associated with fluid retention.

3. Risk for bleeding related to altered clotting factors

Desired outcomes: 

Patient will be free of occult or frank bleeding and will exhibit hemodynamic stability by maintaining a pulse of less than 100 beats per minute. A systolic blood pressure of at least 90 mmhg and a respiratory rate if 12-20 breaths per minute.

InterventionsRationals
InterventionsRationals
Monitor vital signs for indicators of bleeding or hemorrhage.Tachypnea, hypotension, and tachycardia may be associated with bleeding or hemorrhage. This can occur with anticoagulant therapy and will need prompt intervention.
At the minimum of every eight hours, inspect for any wounds that may have resulted from invasive procedures. Also check the oral mucosa and nares.This assessment will determine if there is any bleeding from anticoagulant therapy. Notify the physician immediately.
If patient is on heparin, monitor the PTT (partial thromboplastin time)Need to ensure that the PTT stays within the therapeutic range of 1.5-2.50 X control.
If patient is on Coumadin, monitor the PT (prothrombin time).Need to ensure that the PT stays within the therapeutic range of 1.5-2.50 X control, or INR value of 2.0-3.0.

Other nursing diagnosis:

Knowledge deficit

Disturbed body image/ Self esteem

Risk for acute confusion

Disclaimer:

Please follow your facilities infection control guidelines. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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