Hepatitis B

“serum hepatitis, post-transfusion hepatitis”


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Double shelled DNA hepadnavirus Spread by sex, blood, and body fluids Severe disease Prolonged illness Chronic problems in ~ 10%

Hepatitis B: Clinical Aspects

Incubation period: 45-180 days, average 60-90 days Onset insidious (subtle and treacherous) Symptoms more severe

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Malaise, arthralgias, rash, nausea & vomiting

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Often hospitalized One in 200 die from acute disease Chronic liver disease kills ten times as many

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Sexual etc. Sexual etc. bloodproducts. Parental. Parental. bloodproducts. Faeco-oral route . bloodproducts.VIRAL HEPATITIS – TYPES & PATTERNS Hepatitis -A Hepatitis -B Hepatitis -C Hepatitis -D Hepatitis -E Causative organism Types of Virus Incubation Period Hepatitis – A Virus Nonenveloped RNA Virus 15-45 days Hepatitis -B Hepatitis -C Virus Virus Enveloped DNA Virus Single stranded RNA Virus Hepatitis -D Virus Deprive RNA Virus Hepatitis -E Virus Single stranded RNA Virus 30-180 days 15-160 days 30-180 days 14. Perinatal. Sexual etc.rarely blood borne Parental. Perinatal.60 days Transmission Faeco-oral route. Perinatal.

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Anti HCV Anti HCV- IgM antiHDV.aviod blood contaminatn.IgM.safe sex -NACoinfection/superinfec tion to Hepatitis-B -NAAsymptmatic Fatal acute liver failure Therapy Preventive measures Non specific IgG Vaccine Improve hygeine Non specific HBV Vaccine.IgG.anti HBC Anti Hbs .aviod blood contaminatn.RNA.aviod blood contaminatn.RNA.HDV RNA IgG anti HDV IgM Anti HEV/IgG Anti HEV Rarely Chronic infection IgG anti HAV rarely IgG anti HAV rarely IgG anti HAV Asymptmatic Fatal acute liver failure Past infection IgG anti HDV -NA- Previous immunization Spectrum of disease -NAAsymptmatic Acute /chronic subclinical/rapidl y prograssive Interferon+/Rebiverine None.IgG.safe sex Non specific Improve hygeine .anti HBC Anti Hbs Asymptmatic Acute /chronic subclinical/rapidl y prograssive Interferon+/Lamivudine HBIG vaccine. Anti HCV HCV.SEROLOGICAL MARKERS Acute infection Hepatitis-A Hepatitis-B Hepatitis-C Hepatitis-D Hepatitis -E IgM anti HAV HbsAg.anti HBC HBeAgHBV DNA HbsAg.HDV Ag.safe sex HCV.

etc) Blood transfusion Perinatal  Permucosal   Sexual contact Continuous close contact .Hepatitis B: Transmission   Virus present in blood. drugs. semen. piercing. saliva Percutaneous    Contaminated needles (tattoos.

Concentration of Hepatitis B Virus in Various Body Fluids High Blood Serum wound exudates Moderate semen Vaginal fluid Saliva Low urine feces sweat tears breast milk .

Signs and symptoms           Yellowish eyes and skin called jaundice Swollen stomach or ankle Easy bruising Tiredness Upset stomach Fever Loss appetite Diarrhea Light colored stool Dark yellow urine .

Hepatitis B Diagnosis/Serology IgM anti-HBc (core antibody)   Appears early Persists for 6 months HBsAg (surface antigen)   Detectable 30-60 days after exposure May indicate chronic carrier status Develops after resolved infection Indicates long term immunity HBsAb (antibody to surface antigen)   .

Anti-HBc/HBcAb (antibody to core antigen)  Develops in all HBV infections HBeAg (E antigen)    Indicates HBV replication Correlates with high infectivity Present in acute or chronic infection Anti-HBe (antibody to E antigen)   Develops in most HBV infections Correlates with lower infectivity .

Chronic Carrier State Risk of chronic 90% of infants infection is lower 30% of 5 year olds after acute illness 6% of adults Prolonged infection can occur without signs or symptoms of acute or chronic illness } .

Hepatitis B is an STD  Many prostitutes in the Philippines. Thailand. and developing countries are hepatitis B carriers Sexual activity is #1 risk factor in U.S.  .

sex.Hepatitis B Prevention  Education  Needles. active immunity Post-exposure Passive immunity  Vaccine   HBIG   . universal precautions Pre-exposure.

 . claims to be more efficacious and efficient) Lamivudine . most patients will respond favorably. However. tendency to relapse on cessation of treatment. Another problem is the rapid emergence of drug resistance. Response rate is 30 to 40%.a nucleoside analogue reverse transcriptase inhibitor. alpha-interferon 2b (original) alpha-interferon 2a (newer.Medication       Interferon . Well tolerated.for HBeAg +ve carriers with chronic active hepatitis.

HBV-DNA.     Adefovir – less likely to develop resistance than Lamivudine and may be used to treat Lamivudine resistance HBV. However more expensive and toxic Entecavir – most powerful antiviral known. similar to Adefovir Successful response to treatment will result in the disappearance of HBsAg. and seroconversion to HBeAg .

Surgery  Liver transplantation .

Intervention: Promote bedrest/chair during toxic state.  .Nursing dx Fatigue R/T Decreased metabolic energy production Desire outcome: Report improved sense of energy Perform ADLs and participate in desire activity at level of ability.

Encourage use of stress management techniques.   Provide quiet environment limit visitor as needed. radio tv.g progressive relaxation. (e. Recommend change position frequently. reading .

capillary refill. and strong peripheral pulses. Intervention:  Monitor I and O compare with periodic weight note enteric losses e. AEB stable vital signs. risk for deficiency risk factor excess losses through vomiting and diarrhea 3rd space shift altered clotting factor Desire outcome: maintain adequate hydration.  Asess vital sign and peripheral pulses.Fluid volume.g vomiting and diarrhea. capillaryrefill . good skin turgor.

Skin turgor. and mucous membrane.g hematuria melena.  Check for ascites edema formation measure abdominal girth as indicated.  Observe for signs of bleeding e. .

Intervention:  Contract with patient regarding time for listening  encourage discussion of feeling and concern. length of illness recovery period. Desire outcome: verbalization of change in lifestyle. confinement isolation. .Self esteem. fear of rejection. situational low R/T annoying debilitating symptoms. feeling of helplessness. reaction of others negative feelings about the body.

O offer diversional activities based on energy level .  Asess effect of illness in economic factors of patient and S.