HEPATITIS A, C and D

Aquino, John Lendl

Zabala, Catherine
Hepatitis A
Causative Agent:
Hepatitis A virus (ribonucleic acid virus of
the enterovirus family)

Spread via the fecal-oral route by the oral ingestion

of fecal contaminants.

May also be spread by oral-anal sexual activity.

Sources of infection: contaminated water, shellfish
caught in contaminated water, and food contaminated by
food handlers infected with HAV.

Incubation Period: 15-50 days

NOT LIFE THREATENING!

May be more severe in individuals older than 40 years

old and it can also complicate pre-existing liver disease.
Clinical Manifestations:

Fatigue
Nausea and vomiting
Abdominal pain or discomfort, especially in the area of
your liver on your right side beneath your lower ribs
Loss of appetite
Low-grade fever
Dark urine
Muscle pain
Itching
Yellowing of the skin and eyes (jaundice)
Diagnostics:
Hepatitis A antigen (may be found in stool 7-10 days
before illness, and 2-3weeks after symptoms appear
Anti-HAV - appears in serum soon after onset of
symptoms, disappears after 3-12 mos
IgM anti-HAV - indicates recent infection, (+) up to 6mos
after infection
Serum liver enzymes - ↑ alanine amino transferase
(ALT) and aspartate
aminotransferase (AST)
levels
- ↑ or normal Alkaline phospahate
levels
- ↑ serum total bilirubin levels
(consistent with the clinical
appearance of jaundice
Medical Management:

No specific medication to cure infection with hepatitis A

Immune globulin – given to people who are likely to be exposed to

someone who is infected with hepatitis A.

An antiemetic to relieve nausea may be prescribed.

During the period of anorexia, the patient shouldreceive small

frequent feedings, supplemented, if necesssary by IV fluids with
glucose

Gradual but progressive ambulation seems to hasten recovery,

provided the patient rests after activity and does not participate in
activities to the point of fatigue.
Nursing interventions:
Assist in coping with temporary disability and fatigue

Instruct to seek additional health care if symptoms

persist or worsen

Health teaching about:

>diet
>rest
>follow-up blood work
>avoidance of alcohol
>sanitation (safe food and water supply, effective
sewage disposal) and personal hygiene (hand washing
after BM, before eating)
 Hepatitis C

Causative agent:
Hepatitis C virus (enveloped, single-stranded
RNA virus)

Transmission is blood to blood, most commonly spread by:

>Illicit IV drug needle sharing
>Blood, blood products, or organ transplants
>Needle stick injury with HCV-contaminated blood (healthcare workers
at risk!!!)
>Tattoos
>Intranasal cocaine use (sharing of intranasal cocaine)
Incubation period: 21-140 days

Asymptomatic and not diagnosed until many months

or years after the initial exposure when an abnormality is
detected or when symptoms of liver impairment appear.

Most people with Hepatitis C do not clear the virus

and a chronic infection develops.
Clinical Manifestations:

Fatigue
Fever
Nausea or poor appetite
Muscle and joint pains
Tenderness in the area of your liver
Diagnostics:
Enzyme-linked immunosorbent assay (ELISA)
- initial screening test
Recombinant Immunoblot Assay (RIBA)
- more specific assay

THESE TESTS CONFIRM THAT THE CLIENT HAS

BEEN EXPOSED TO HCV AND HAS DEVELOPED
THE ANTIBODY

Polymerase chain reaction

- confirms active virus and can quantify viral load
Medical Management:

Pegylated interferon alpha (pegasys, PEG-Inton) –

often combined with an antiviral drug called ribavirin

For end-stage liver disease, the only treatment is LIVER

TRANSPLANT
Nursing interventions:

advise client/family member that there is no benefit from

rest, diet, or vitamin supplements

WOF: hemolytic anemia -> side effect of drug, may be

severe enough to require discontinuation of treatment
Hepatitis D
Causative Agent:
Delata Hepatitis, or HDV (defective RNA
virus that needs the helper function of
HBV)

Transmitted primarily by parenteral routes

Incubation period: 14-56 days

Clinical Manifestations:
Fatigue
Excessive tiredness
Not feeling very hungry
Nausea or vomiting
Diarrhea
A low-grade fever
Muscle pain
Joint pain
Sore throat
Mild abdominal pain (or stomach pain)
Dark urine
Light-colored stool.
Medical Management:

Treatment consists primarily of support. Observe

synthetic liver function markers and mental status
closely. Deterioration of either should prompt early
consultation with hospital personnel capable of
performing liver transplantation.

LIVER TRANSPLANTATION

Antiviral therapy with interferon alfa can be

considered in patients with chronic infection.
Diagnostics:

HDAg – Hepatitis delta antigen, detectable in early acute

HDV infection

Anti-HDV- antibody to HDV, indicates past or present

infection with HDV

Anti-delta antibodies in the presence of HBAg on testing

confirm the diagnosis
Nursing Interventions:

Provide adequate nutrition, low in fat and high in

carbohydrates.

If the client is infected moderate protein is required, if the

client is recovering then high protein diet is required, and
if there is a complication of the hepatitis then low protein
is required.