CHAPTER I

PRELIMINARY
1. Background
Viral hepatitis is a systemic infection by a virus accompanied by necrosis and inflammation of the liver cells
that produces a unique set of clinical, biochemical and cellular changes. To date five definite types of viral hepatitis
have been identified: hepatitis A, B, C, D, E. Hepatitis A and E have a similar mode of transmission (faecal - oral
route) while hepatitis B, C, and D have many characteristics. same.
Hepatitis may occur as a secondary infection during the course of infection with other viruses, such as:
• Cytomegalovirus
• Epstein-Barr virus
• Herpes simplex virus
• Varicella-zoster virus
Clients usually recover completely from hepatitis, but are likely to have residual liver disease. Although hepatitis
mortality is relatively long, acute viral hepatitis can end in death.
1.2 Purpose
1.2.1 General objectives
Students can find out problems about hepatitis and nursing care for clients with hepatitis.

1.2.2 Special Purpose

Specifically "Hepatitis" is structured so that:
1. Students can find out about understanding, etiology, classification, clinical manifestation, pathophysiology,
supporting examination, management, and nursing process.
2. Students can identify nursing care for clients with hepatitis.
3. Students can identify the health education needed in patients treated with hepatitis complaints.
4. So that this paper can be a teaching material for other students about various matters related to hepatitis.
CHAPTER II
BASIC CONCEPTS

2.1 Definition
Hepatitis is an inflammatory disease of the liver that can be caused by a variety of causes, including viral infections
or exposure to toxic materials. In viral hepatitis, prolonged or recurrent liver inflammation, which is usually
associated with chronic alcoholism, can cause cirrhosis, a condition in the form of replacing hepatocytes that are
permanently damaged by connective tissue. Liver tissue has the ability to undergo regeneration, and under normal
circumstances undergo a gradual exchange of cells. If part of the liver tissue is damaged, the damaged tissue can be
replaced by increasing the rate of division of healthy cells. There seems to be a factor in the blood that is
responsible for regulating liver cell proliferation, although the nature and mechanism of these regulatory factors
remains a mystery. However, how quickly hepatocytes can be replaced has a limit. In addition to hepatocytes,
among the liver plates also found several fibroblasts (connective tissue cells) that form supporting tissue for the
liver. When the liver is repeatedly exposed to toxic materials, such as alcohol, so often, that new hepatocytes cannot
regenerate fast enough to replace damaged cells, strong fibroblasts will take advantage of the situation and carry out
excessive proliferation. This additional connective tissue causes space for hepatocyte regrowth to decrease.
Hepatitis is a diffuse inflammation process in tissues that can be caused by viral infections and by toxic reactions to
drugs and chemicals. (Sujono Hadi, 1999). Hepatitis is inflammation of liver cells that spread / spread, viral
hepatitis is the most dominant type. Injury to the liver with inflammation can develop after opening for a number of
pharmacology and chemicals from inhalation, ingestion, or parenteral (IV) drug administration. Toxin and Drug
induced Hepatitis are the result of opening or opening of hepatotoxins, such as: industrial toxins, alcohol and
medications used in medical therapy.
The term "hepatitis" is used for all types of inflammation in the liver (liver). The causes can be various kinds,
ranging from viruses to drugs, including traditional medicine. There are also several types of hepatitis viruses,
hepatitis A, hepatitis B, C, D, E, F and G. The manifestations of viral hepatitis can be acute (hepatitis A) can also be
chronic hepatitis (hepatitis B, C) and those that later become cancerous liver (hepatitis B and C).
hepatitis which is usually caused by drugs, alcohol (alcoholic hepatitis), and obesity and metabolic disorders that
cause nonalcoholic steatohepatitis (NASH) are called Hepatitis Nonviruses.
2.2 Epidemology
The increasing incidence of viral hepatitis is increasingly becoming a public health problem. The disease is
important because it is easily transmitted, has a high morbidity and causes the sufferer to be absent from school or
work for a long time. 60% to 90% of cases of viral hepatitis are estimated to go unreported. The existence of
subclinical cases, failure to recognize mild cases and misdiagnosis are thought to have contributed to under
reporting of the real situation. Although approximately 50% of adults in the United States have antibodies to the
hepatitis A virus, many people do not recall previous episodes or events that showed symptoms of hepatitis.
2.3 etiology
1. Viruses of hepatitis A, B, C, D, E and G, each of which causes different types of hepatitis.
2. Alcohol
3. Drug poisoning

2.4 Classification
1. Parenteral and Sexually Transmitted Hepatitis Virus
Hepatitis B
Hepatitis B is a virus that is often studied because it can be tested, the prevalence of the disease. Morbidity and
mortality are associated with disease.
Hepatitis B infection is found worldwide, causing 250,000 deaths per year. Since 1982, an effective vaccine from
hepatitis B is available and a campaign to reduce the disease will allow a decrease in the impact of this disease in
the future.
Transmission. Areas where the disease is endemic (Polar, African, Chinese, South Asian and Amazonian), the most
common form of transmission is perinatally from an infected mother to her baby. In developing countries with
lower disease prevalence, the main routes of transmission are sexual and parenteral. In the United States, high-risk
populations include homosexual men, intravenous drug users, health care workers and those who get blood
transfusions.
Pathophysiology. The virus must be able to enter the bloodstream by direct inoculation, through the mucous
membrane or damage the skin to reach the liver. In the liver, replication needs incubation 6
weeks to 6 months before the host experiences symptoms. Some infections are not seen for those who experience
symptoms, the degree of liver damage, and their relationship with fever followed by rashes, yellowish, arthritis,
stomach cramps, and nausea. In extreme cases, liver failure can occur followed by encephalopathy. Mortality is
associated with severity approaching 50%.
Primary or non-primary infection appears clinically, resolving itself within 1 to 2 weeks for most patients. In less
than 10% of cases, the infection can persist for decades. Hepatitis B is considered as a chronic infection when the
patient has a residual infection at the end of 6 months. Complications associated with chronic hepatitis can be
severe, with liver cancer, cirrhosis and ascites occurring within a few years to decades after initial infection.
Diagnosis. Serological tests for hepatitis will provide diagnostic information and information about the level of
transmission and possible stages of the disease. The test is directly related to the virus and antibodies produced by
the host in response to the protein. Viruses have a core and an outer covering. Protein is related to the core antigen
and surface antigen. Laboratory tests for core antigens are not available, but surface antigens often show HBsag,
which can be detected, within the first few weeks of infection. An increase in titer over several weeks and also a
decrease in the level that can not be detected. The presence of HBsag provides an infection at that time and the
transmission rate is relatively high. Other antigens that are part of the virus are called e antigens (HBeag). HBeag is
a very sensitive marker of sharpness because it can be detected in the closest estimate at the time of clinical disease
and at a time when it appears that the risk becomes greater for infectious disease.
Vaccine. Hepatiic B vaccine is produced by using hepatitis B antigens to stimulate antibody production and to
provide protection against infection, safety, and effectiveness close to 90% of vaccinations. Because the hepatitis B
virus is easily transmitted by syringes in the health care area. Reducing perinatal infections and the risk of
transmission after birth, the hepatitis B vaccine is given routinely to babies after birth. Individual vaccinations
(previously uninfected) will have a positive hepetitis B serology only on HBsab. This guarantees the immunity
produced by a vaccine that can be distinguished from natural production, when a core of antibodies also exists.
Hepatitis C
Until now, Non-A, Non-B hepatitis shows a picture of hepatitis virus that is not hepatitis A, B or other causative
agents. Many of the Non-A, Non-B hepatitis is transmitted through parenteral. This was previously unknown and
this virus is not
known and now identified and called hepatitis C. Then, an antibody test to check the patient for this agent is
available.
Pathophysiology. Hepatitis C is now estimated to infect around 150,000 people per year in the United States. This is
considered to be a disease that is transmitted almost always through blood transfusions. However, there is evidence
that the virus is transmitted by other methods (sharing with contaminated jars by intravenous drug users and
accidental needle punctures and other injuries to health workers). There is further evidence that the virus is
transmitted through sexual contact.
Diagnosis. Serologic tests can now be done to detect the hepatitis C virus with antibodies that are interpreted in a
limited way. Many patients who have clinical symptoms of hepatitis virus need to be tested.
Liver function tests are used to get hepatitis status. This disease is not very well understood at this time, but it is an
improvement and usually found a repeated decrease in liver enzymes. With this information and other clinical signs,
it is believed that as many as half of all patients experience hepatitis C infection that develops into chronic infection.
This has shown the main causes of chronic liver disease and cirrhosis in the United States.
Management. At present, there is no known post-exposure prophylactic therapy, vaccine or prophylactic agent for
hepatitis C. Health care workers must follow the general precautionary principle to minimize the risk of
occupational transmission. This principle is based on the understanding that infected populations are carriers of this
disease. Attention to needles and proper precautions must be used in all patients.
Hepatitis D
Hepatitis D is a virus that depends on the hepatitis B virus which is more complex to survive. Hepatitis D is only a
risk for those who have positive hepatitis B surface antigens
Hepatitis D is suspected when the patient is acutely ill with new or recurring symptoms and has previously
experienced hepatitis B or as a carrier of hepatitis B.
There is no specific action for hepatitis. Prevention for this virus is achieved as a secondary benefit of the hepatitis
B vaccine. Preventive behavior towards this blood virus (not using interchangeable needles and using condoms
during sexual intercourse) must be emphasized in people infected with hepatitis B who are not infected with
hepatitis D.
2. Viral hepatitis transmitted through the faecal - oral route
Hepatitis A

Hepatitis A is a virus that is almost always transmitted through the faecal-oral route. This virus causes acute
hepatitis without chronic or permanent state as indicated by the blood hepatitis virus.
In children, this disease is often not recognized or seen with complaints that are not severe. Symptoms are more
visible in adults and can range from weakness to fever, jaundice, nausea and vomiting. This disease usually lasts 1
to 3 weeks. Patients rarely need treatment in the hospital and when symptoms occur, they are very unlikely to be
transmitted to others.
Because it can be transmitted with contaminated food and water, hepatitis A can be a potential epidemic in poorly
managed countries. The person preparing an infected food has the potential to transmit the disease to others if
personal hygiene is not done properly.
Available hepatitis A antibody tests detect IgM which shows acute or recent infection. Or IgG which shows the
infection has healed.
Hepatitis E
Hepatitis E is a viral infection that spreads through contamination of food and water through the faecal-oral route.
Until now, infection has been called hepatitis A Non-A Non-B. Diagnosis is made by getting rid of hepatitis A, B,
and C and determining the most likely from contaminated food or water sources. Now that tests for antibodies for
hepatitis E are available, epidemiological studies will be very facilitated
Hepatitis E has rarely been found in the United States, but is associated with epidemics from contaminated water in
Asia, Africa, and the Soviet Republic. In the United States, hepatitis E should be considered some people who have
traveled abroad and have symptoms of the hepatitis virus but are serologically negative for other hepatitis viruses.

5. Clinical features
Clinical features of viral hepatitis can range from asymptomatic to conspicuous disease, liver failure and death.
There are three stages in all types of hepatitis: the prodromal stage, the stage of jaundice, and the covalation
(recovery) period
1. The prodromal stage, called the prethera period, begins after the period of the budding virus is over and the
patient begins to watch for signs of the disease. This stage is called praicterus because jaundice has not
appeared yet. Individuals will be very infectious at
this stadium. Antibody against viruses is usually not found. This stadium lasts 1-2 weeks marked by:
• General Malese
• Fatigue
• Symptoms of an upper respiratory tract infection
• Myalgia (muscle aches)
• An aversion to most foods
2. Jaundice stage is the second stage of viral hepatitis, and can last 2-3 weeks or more. In most people, this
stage is characterized by, as the name implies, the appearance of jaundice. Other manifestations are:
• The worsening of all the symptoms at the prodormal stage
• Enlargement and pain in the liver
• Splenimogali
• It may be itching (pruritus) on the skin
3. Recovery stage is the third stage of viral hepatitis and usually occurs within 4 months for hepatitis B and C
and in 2-3 months for hepatitis A. During this period:
• Symptoms subside, including jaundice
• Appetite is recovering

2.6 Pathophysiology
The hepatitis virus that attacks the liver causes inflammation and infiltrates in hepatocytes by
mononucleous cells. This process causes liver perenchyn cell degeneration and necrosis.
The inflammatory response causes inflammation in blocking the liver drainage system, causing destruction
of the liver cells. This situation becomes static bile (biliary) and bile cannot be excreted into the gallbladder
even into the intestine, so it increases in the blood as hyperbilirubinemia, in urine as urobilinogen and
hapatocelular skin jaundice.
Hepatitis occurs from asymptomatic until the pain comes with mild symptoms. Liver cells undergo
complete regeneration in 2 to 3 months more seriously when with liver necrosis and even death. Hepatic
with sub acute and chronic can be permanent and the occurrence of interference with liver function.
Individuals with chronic illness and risk of developing it will become chronic liver disease or liver cancer.
1. Diagnostic Check
1. Liver function test: abnormal (4-10 times normal). Note: is a value limit for distinguishing viral hepatitis
from nonviruses
2. AST (SGOT or ALT (SGPT): initially increased. May increase one to two weeks before jaundice then
appear to decrease
3. Complete blood: SDM decreases due to decreased HR life (liver enzyme disruption or bleeding)
4. Leucopenia: thrombocytopenia may be present (splenomegaly)
5. Complete blood differential: leukocytosis, monocytosis, atypical lymphocytes, and plasma cells
6. Alkaline phosphatase: slightly increased (unless there is severe cholestasis)
7. Fesses: clay color, steatorea (decreased liver function)
8. Serum albumin: decreased
9. Blood sugar: transient hyperglycemia / hypoglycemia (hepatic fusions)
10. Anti-HAV IGM: Positive in type A
11. HBSAG: can be positive (type B) or negative (type A). note: is diagnostic before kinik symptoms occur
12. Prothrombin mass: may be prolonged (liver dysfunction)
13. Serum bilirubin: above 2.5 mg / 100mm (if above 200mg / mm, poor prognosis may be associated with
increased cellular necrosis)
14. BSP excretion test: increased blood levels
15. Liver biaosi: determine the diagnosis and extent of necrosis
16. Liver scan: helps in estimating the severity of parenchymal damage
17. Urinalysis: elevated levels of bilirubin; protein / hematuria can occur

2.8 Management
Viral hepatitis treatment is mainly supportive and includes:
• Rest as needed
• Education about avoiding alcohol or other drugs
• Education about ways of transmission to sexual partners and family members
• Families and hepatitis patients are offered to receive pure globulin gamma specific to HAV or HBV that
can provide passive immunity against infection. This immunity is temporary
• The FDA recently gave permission for the hepatitis A vaccine to be given. This vaccine is made from the
inactive hepatitis virus. Studies show that this vaccine is 96% effective after one dose.
• Vaccines available for HBV, due to the highly infectious and potentially fatal nature of the virus, it is
strongly recommended that all individuals in the group are at high risk, including health workers or people
who are exposed to blood products, vaccinations. Also recommended for vaccination are people who are at
risk of the virus, including sexually active homosexuals or heterosexuals, drug addicts, and infants.
• Vaccination against HBV is produced by intramuscular injection of recombinant DNA three times at
predetermined intervals. The first and second doses are given one month apart, and the third dose is given 6
months after the second dose. This vaccination is 85% effective in forming immunity.

2.9 Complications
Complications of hepatitis are the emergence of chronic hepatitis that occurs when the individual continues
to show symptoms and viral antigens for more than 6 months. Clinical features of chronic or fulminant
active hepatitis may embrace the picture of liver failure above, with death occurring within 1 week to
several years later.

Nursing diagnoses
1. Changes in nutrition: less than need related to failure of input to meet metabolic needs: anorexia, nausea /
vomiting and impaired absorption and metabolism of food digestion: decreased peristalsis (visceral
reflexes), restrained bile.
2. Disorders of comfort (pain) associated with swelling of the liver experiencing inflammation of the liver
and portal vein dam.
3. Ineffective breath pattern associated with intra-abdominal fluid collection, ascites decreased lung
expansion and secretion accumulation.
CHAPTER V
Conclusions and recommendations
1. Conclusions.
Hepatitis is a public health problem that needs to be addressed immediately, given the high prevalence and
consequences of hepatitis. Transmission of hepatitis occurs through contact with blood / blood products,
saliva, semen, tools contaminated with hepatitis and inoculation of percutaneous and subcutaneous by
accident. Parenteral and non parenteral transmission as well as vertical and horizontal transmission in the
family or environment. The risk of getting hepatitis in the community is related to living habits that include
sexual activity, free lifestyle, and work that allows contact with blood and patient material. Control of this
disease is more possible through prevention than treatment that is still under research. Prevention includes
prevention of disease transmission through Health Promotion and Specific Protection activities, as well as
prevention of diseases with active and passive immunization.
After acute viral hepatitis, a small number of patients will experience aggressive or chronic active hepatitis
where liver damage occurs such as being gnawed (piece meal) and developing cirrhosis. This condition is
distinguished from persistent chronic hepatitis with liver biopsy. Corticosteroid therapy can slow the spread
of liver injury, but the prognosis remains poor. Death usually occurs within 5 years due to kidney failure or
cirrhosis complications. Active chronic hepatitis can develop in almost 50% of patients with HCV; while
the trophies in HBV sufferers are much smaller (around 1-3%). Chronic hepatitis should not generally be a
complication of HAV or HEV. Not all cases of active chronic hepatitis occur following acute viral hepatitis.
Drugs that can be involved in the pathogenesis of this disorder include alfamethyldopa (aldomet, isoniazid,
sulfonamide and aspirin).
 2. Suggestions
To deal with diseases that have not found a cure such as hepatitis, prevention is our first choice. After
reading and knowing how to spread it, actually we all understand what we have to do to avoid this chronic
disease. Because the transmission route is mainly by injection, each time the injection has to be sure that the
needle is sterile. What is practical is use
new or disposable needle (disposable flue). And the most important thing is to vaccinate, the vaccine is a
substance (antigen) which if injected into our body can stimulate the immune system to produce anti-
antibodies against the antigen.
It is better for hepatitis sufferers to immediately get treatment as soon as possible so it does not get worse to
cause liver cancer. And nurses must provide health education to clients and families of clients who do not
know the dangers and how to prevent hepatitis as early as possible

Daftar Pustaka

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Doenges, Marilynn E. 2000. Rencana Asuhan Keperawatan. Jakarta:Buku Kedokteran EGC.

Sherwood, Lauralee. 2001. Fisiologi Manusia dari Sel ke Sistem. Jakarta: Buku Kedokteran EGC.

Smeltzer, suzzane C. 2002. Keperawatan Medikal Bedah vol 2 Jakarta:Buku Kedokteran EGC.