Hepatitis B

³serum hepatitis, post-transfusion hepatitis´ posthepatitis´ 
   

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 4560days Onset insidious (subtle and treacherous) Symptoms more severe 

Malaise, arthralgias, rash, nausea & vomiting 

 

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

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FaecoFaeco-oral route FaecoFaeco-oral route.rarely blood borne .VIRAL HEPATITIS ± TYPES & PATTERNS Hepatitis -A Hepatitis -B Hepatitis -C Hepatitis -D Hepatitis -E Causative organism Types of Virus Hepatitis A Virus NonNonenveloped RNA Virus 1515-45 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 Incubation Period TransTransmission 30-180 30days Parental. 1515-160 days 30-180 days 14.60 3014days Parental. bloodbloodproducts. Sexual etc. bloodbloodproducts. Sexual etc. Sexual etc. Parental. Perinatal. Perinatal. Perinatal. bloodbloodproducts.

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

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

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) anti  Appears early Persists for 6 months Detectable 30-60 days after exposure 30May indicate chronic carrier status Develops after resolved infection Indicates long term immunity HBsAg (surface antigen)   HBsAb (antibody to surface antigen) (antibody antigen)   .

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

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

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

active immunity PostPost-exposure Passive immunity  Vaccine   HBIG   . sex.Hepatitis B Prevention  Education  Needles. universal precautions PrePre-exposure.

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

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

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.

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

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

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

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

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

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