General objectives

- At the end of the session all the

participants will be able to
know about the hepatitis
 Specific objectives ;
● Introduction of Hepatitis
● Types of Hepatitis
● Pathophysiology of viral hepatitis
● Characteristics of Hepatitis
● Mode of transmission
● Prevention
● Management and treatment
Hepatitis
 Introduction
- Hepatitis is a medical condition
defined by the inflammation of the
liver. Which is most commonly
caused by virus but also be caused
by drug( alcohol) ,chemical,
autoimmune disease and metabolic
abnormalities.
 Types of Hepatitis

1.Viral Hepatitis
2.Alcoholic hepatitis
3.Autoimmune hepatitis
Pathophysiology
Viral hepatitis
 Viral hepatitis
- Hepatitis is one of the infectious
disease caused by a viral infection
affecting the liver and damaging it's
cells, temporarily and permanently
- There are five types of Hepatitis virus
, Hepatitis A,B,C,D and E as well as
other types which are classified with
Contin……
-There are five types of Hepatitis virus ,
Hepatitis A,B,C,D and E as well as other
types which are classified with Hepatitis
G.- Falviridae( but is not known to cause
human disease.)
 1.Hepatitis A

● Hepatitis A is highly infectious,but rarely

fatal.
● In Nepal, hepatitis A virus infection was
most common in children.
● The infection is increasing among
children and within a large poor
communities.
 Incubation period
- Usually ranges between (15-50) days.
- The viruses is detected in the stool of
the people inflected with hepatitis A.
- The infection is usually picked up from
person to another through food and
drinking item contaminated with
hepatitis A infected person.
 Conti…..
- The infection is also transmitted by
eating uncooked food such as some
raw food , vegetable and fruits
without peeling or after cleaning
food with contaminated water.
 Symptoms
- The initial symptoms of the hepatitis
A are similar to the influenza and no
symptoms may appear on children
inflected.
- Nausea and vomiting
- Fever
- Loss of appetite
- Pain at upper right area of abdomen.
- Diarrhoea
- Pain in the body
- Exhaustion and general weakness of the
body
- Change in urine color into the dark
 Prevention
- Providing pure, drinkable water,
- Disposing sewage water in correct
ways,
- Paying attention to the personal
hygiene,such as washing hand
regularly and washing, peeling the
vegetable and fruit before eating.
 Treatment
- There is no specific treatment for the
hepatitis A, and the infected person can be
cured after several week(6weeks) with a
medical follow up .
- The purpose of the treatment is to keep the
patient comfortable and ensure a suitable,
balanced diet including making up for the
fluid lost by vomiting and diarrhea .
 2. Hepatitis B
- It is a viral infection affecting
liver and this disease poses a
major public health problem.
- The infected person is likely to develop a
chronic liver disease or face death as a
result of complication taking such as
cirrhosis or liver Cancer
Contin …

- Surgeons is estimated to be 50 time greater in

risk then general population for hepatitis B
 Incubation period
- Incubation period of Hepatitis B
virus is about to 90 days after
which the symptoms start to
appear on the infected person
,ranging from 60-150 days .
 Ways of infection
- Sexual intercourse
- Contaminated syringe and needles
- Exposure to a prick of a needle
contaminated with the blood of a person
infected with the hepatitis B
- Unintentionally such as people working in
the health feild and laboratory
- From the mother to child birth during
childbirth.
 Acute hepatitis
- Last for less than six month, and
the immune system in the body
can kill the virus in case of
infection. However some cases
may progress to the chronic
stage , if the immune system fails
to fight the virus.
 Symptoms of acute hepatitis;

- Pain in the body,

- Change in urine color to dark color,
- Nausea and vomiting,
- Diarrhea
- Fever
- Dehydration due to severe vomiting
 Chronic Hepatitis
- After a person is infected for more
than six month ,and the immune
system unable to get rid of the virus,
the disease progress to the chronic
Hepatitis.
Potential complications related to
chronic Hepatitis;
● Cirrhosis
● Liver cancer
● Liver failure
 Prevention
- All infant should be vaccinated with hepatitis
B to protect them against the infection,
- The vaccine is given in three separate dose,
- In the area where the virus transmission
rate from the mother to their infant are heigh
, the first dose should be given as soon as
possible after delivery within 24hrs.
-
 Contin ..
- The vaccine is given to all children
and adolescents under the age of 18
years who have never given the
vaccine.
 Treatment
- The treatment of the hepatitis B patient
depends on the virus activeness and the
disease progress.
Treatment of acute hepatitis
- Eating fresh vegetables and fruits -

- Drinking fluids, especially water

- Taking some analgesics.
 Contin…
- Most people infected with acute symptoms
got cured without the need for medical
intervention and drug therapy. But incase
the disease happens to progress or
symptoms to persist for a long time the
doctor may turn to using medication to
treat the symptoms.
 Treatment of chronic hepatitis
- Treatment depends on the extent of
the virus activeness in the body.
- The goal of the treatment is to prevent the
liver from damaged by means of inhibiting
the virus reproduction.
- The antiviral medications are used if thr
virus are active there is a risk of the liver
being damaged.
 Contin…..
- The antiviral medications are not given to
all infected with the chronic hepatitis B;
however they are in need of constant
medical follow up and examination to
determine how active the virus is in the
body and the damage in the liver tissue.
 Liver transplantation
- In the advanced stage of the
chronic liver inflammation, during
which the liver tissue got damaged
the person may need a liver
transplant.
Hepatitis C
- It is caused by virus C and transmitted
through the blood or its products from
the person infected with the virus.
- Most of the people infected with the
hepatitis C don't show any
symptoms,and only through routine
medical test do they know that they are
infected.
 Incubation period

- The incubation period of the hepatitis

C ranges from two weeks to six
month.
 Way of infection and spread
- Sexual contact
- Exposure to a prick from a needle
contaminated by the blood,
- Sharing needle, particularly among those
doing drug,
- The hepatitis C infection is not
transmitted by handshaking or sitting next
to infected person .
 Symptoms
- Loss of appetite
- Nausea and vomiting
- Pain in muscles
- Fever
- Dark urine
- Yellowing of the skin
 Prevention
- Avoiding sharing the personal items like
toothbrush and shaving razors,
- Be cautious when dealing with
contaminated blood, especially those
working in the health field,
- Avoiding a prohibited sexual relations
- Wearing gloves while dealing with
contaminated blood in home accidents .
 Treatment

- The hepatitis C doesn't always required

treatment.
- The antiviral drug can be used as group for
treating the inflammation
eg.elbasvir,lidipasvir etc
Hepatitis D
 - The virus D also called delta virus can
only reproduce in the presence of
another virus ; hence it is always
associated with the hepatitis B virus
- Incubation period : approximately
(2-8)weeks
 Ways of infection

● Blood transfusion or its products,

● Sexual intercourse
● Those doing drug through injection
 Prevention
- So far, there is no vaccination against this
virus , but since the infection with the
virus D only happen with the presence of
the virus B. Then vaccinating against the
hepatitis B provide protection against the
two virus ,even if indirectly in case of the
hepatitis D.
 Treatment
- We can use the same medicine used for
treating the hepatitis B, and the doctor
may turn to using higher dose incase of
getting infected with the viral inflammation
B and D.
Hepatitis E
- The virus is mainly transmitted orally
through having food or drinking items,
contaminated with the hepatitis E. and
the virus is found in the faeces of the
infected person. The cause of infection
is usually down to the drinking water
contaminated with the faeces holding
the virus the disease.
 Incubation period
The incubation period of the hepatitis E
range between 3-8 weeks by an
average of 40 days
 Symptoms
● Jaundice
● General weakness
● Nausea and vomiting
● Weak appetite
● Abdominal pain
● Fever
● Dark urine
 Prevention
- Sterilize drinking water sources,
- Eating non contaminated or cooked
food as the heat distroy the virus,
- Paying attention to the personal
hygiene especially those infected by
washing hand with water and soap after
using the toilet .
 Treatment
- Most cases don't need antiviral drug, but a
patient may need rest and eat fresh
vegetables and fruits as well as sufficient
amount of fluid.
- In case where the disease is progressing
and showing complications the person may
be in need of an appropriate medical
intervention.
2.Alcoholic hepatitis
- Excess heavy consumption over an
extended period of time can cause liver
damagae and inflammation.This may also
called as a acholic hepatitis.
- The alcohol directly injures the cells of
your liver.Overtime it can cause
permanent damage and lead to liver
failure and cirrhosis.
- Patients needs to stop consuming
alcohol.
-significant amount of alchol that may
lead to liver damage.
*For men:>75/100ml per day for 20
years.
*For women:>35ml/per day.
-Other toxins causes of hepatitis induce
overdose or overuse of medication and
exposure to poisons.
Pathogenesis
Sign and Symptoms
✓Pain and Swelling in abdomen
✓Fever
✓Decreased appetite and weight loss
✓Jaundice
✓Hepatomegaly
✓Nausea and vomiting
Diagnostic Evaluation
✓History Taking
✓Physical Examination
✓Blood Test
✓Liver function test
✓CT scan
✓Liver biposy
Prevention
✓Stop drinking
✓Modify your daily lifestyle
✓Corticosteroids should be given
✓Hepatoprotective agents
✓Supportive care .
 Autoimmune Hepatitis
✓Autoimmune hepatitis occur when your
body's immune system turns against liver
cells.
✓It is a long-term chornic liver disease that
cause inflammation and permanent damage
which can lead to scarring of the liver and
liver damage.
✓There is no cure for autoimmune hepatitis
but treatment can help you manage your
symptoms and prevent damage to your liver.

✓Autoimmune hepatitis is categorised as

type 1 and type 2
#Autoimmune hepatitis type 1:-
This is the most common type of the
disease.It’s most common in a adults.It is
usually found in north america.
Autoimmune hepatitis Type 2
This type of disease can develop most
common in children.It can be more difficult to
treat
Cause
Autoimmune hepatitis may appear suddenly
or develop.The cause of the disease is not
known,but in some cases may be related to
other systemic disease or exposure to
medications or drug and viruses.
✓Autoimmune hepatitis can also be inherited
from a parents and grandparents who also
has the disease.
Sign and Symptoms
✓Fatigue
✓Dark urine
✓Clay Stool
✓Abdominal pain
✓Unexplained weight loss
✓Joint and muscle joint.
 Diagnosis Evaluation

✓Histroy Taking
✓Physucal examination
✓Liver function Test
✓Blood test
✓Ultrasound
✓Liver biopsy
 Nursing Management
✓Assessment
*Assess for general appearance, systemic
and liver related symptoms.
✓Obtain history taking.
✓Asses size and texture of liver to detect
enlargement of liver
✓Obtain vital sign.
 Nursing Diagnosis
✓Imbalance nutrition less than body
requirements related to the effects of liver
dysfunction.
✓Deficient fluid volume related to nausea
and vomiting.
✓Activity intolerance related to coagulopathy.
✓Risk for infection due to immuno
suppression.
 Nursing Interventions.
✓Assess body weight and measure
abdomen girth.
✓Provide patient with a special diet that
restricts sodium,high fat diet and protein.
✓Provide rest according to patient level of
fatigue.
✓I/V fluids and electrolyte replacement.
✓Give analgesics as ordered.
✓Provide quiet and calm environment.
 ✓Evaluate patients current activity
tolerance and adjust activity and reduce
intensity of task
✓Administer Antiemetic drugs
✓Cortiosetriods, Prednisone should be
administered.
✓Liver transplant