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1. HEPATITIS
By L. Chifwaila

3. Definition
• It is the inflammatory disease of the of the liver that may be
caused by, drugs, alcohol, chemicals, autoimmune diseases
and viruses and is usually characterized by impaired hepatic
functions.
• It is the inflammation of the liver cell usually resulting in
impaired liver function

4. Classification
• It is usually classified according to the cause and duration i.e.:
Toxic hepatitis
Auto immune hepatitis
Drug induced hepatitis
Viral hepatitis caused by:
Hepatitis A Virus
Hepatitis B Virus

5. Classification cont
Hepatitis C Virus
Hepatitis D Virus
Hepatitis E Virus
Hepatitis F and G have been identified but are uncommon
However the commonest forms of viral hepatitis are Hepatitis
A. B, and C
It may also be called acute or chronic

6. Hepatitis A
• It is the type of hepatitis that is caused by hepatitis A virus (an
RNA picornavirus).
• The incubation period is 2-6weeks

7. MODEOF SPREAD:
It is spread by the fecal oral route that is;
• Food preparers who are infected can pass the virus on if they
do not wash their hands with soap and water after having a
bowel movement, especially when they prepare uncooked
foods.
• Fecal contamination of food and water.

8. Hepatitis A Mode of spread
cont
• Anal/oral contact, by putting something in the mouth that had
been contaminated with infected feces.
• Diaper changing tables, if not cleaned properly or changed
after each use, may facilitate the spread of HAV.
• Fecal residue may remain on the hands of people changing
soiled diapers.

9. Possibleout comes of the disease
• Hepatitis A will clear up on its own in a few weeks or months
with no serious after effects.
• Once recovered, an individual is then immune for life to HAV
through the presence of the IgG antibody .
• About 1 in 100 HAV sufferers may experience a sudden and
severe (i.e., "fulminant") infection.

10. Pathophysiology
• Hepatitis virus invade the liver cells
• It take hostage of the liver cell and destroy it after reproducing
• The body attacks the HAV with antibodies
• This leads to the regeneration and resuming of normal
function of the liver
• A person who recovers remains protected for life

11. Signs and symptoms
• It is possible to experience mild or no symptoms
whatsoever, but even if this is the case the
person’s faeces will still be infectious to others.
Many people who become infected with HAV
will have symptoms that include
fatigue.
Nausea, vomiting and diarrhea.
Loss of appetite.
Weight loss.
Fever
Joint pains
 NOTE: These symptoms are seen in the preicteric
phase(before onset of jaundice)

12. Signs and symptoms
The icteric period will have the following
symptoms:
Jaundice (yellow skin and whites of eye)
Dark yellow urine
Pale feces (clay colored stool).
Itchy skin.
Abdominal pain especially around the right
hypochondriac region
Diarrhea
The infection usually clears up in to 2 months,
but may occasionally recur or persist longer in
some people.

13. Diagnosis
• Obtain a thorough patient history to assess the
likelihood of hepatitis A infection.
• Use clinical evaluation to support the diagnosis
of hepatitis A.
• Confirm the diagnosis of hepatitis A with
appropriate laboratory testing. IgM anti body to
HAV
• Use serologic testing to exclude HAV infection in
persons with unexplained acute liver failure.

14. Diagnosis cont
• Blood to r/o hepatitis B and C
• liver function (laboratory evaluation of: urine
bilirubin and urobilinogen, total and direct
serum bilirubin, ALT and/or AST, alkaline
phosphatase, prothrombin time, total protein,
albumin, IgG, IgA, IgM
• Liver scan will show change in the liver
• Stool for electro microscopy
• Urine for urobilinogen

15. Treatment
• No specific treatment is necessary for hepatitis A. Disease
• IV fluids to prevent dehydrated, 5% Dextrose 1 litre /24hours.
• Anti emetics to counteract nausea and vomiting, e.g.
phenegan 10mg bd
• Anti histamine to control itching phenegan 5-10mg
• Enough rest to promote recovery
• A balanced diet is given (low fat high carbohydrate is well
tolerated)
• Vitamin C in high doses may help to quicken recovery 40-
100mg orally(reducing the virus and clearing the jaundice)
• Glucose drink for energy

16. Treatment cont
• Glucose to promote rest of the liver there by promoting
recovery
• Vitamin B complex
• Vitamin A 10mg im
• Prednisolone 30mg od for 14/7 then reduce till you stop
• Analgesics for pain e.g. panadol 500mg tds for 3/7

17. Prevention
• Vaccination against hepatitis A is the most effective method
where available
• Good hand hygiene may prevent spread during out breaks
• Using clean utensil can prevent spread
• Cooking food well
• Prophylaxis with anti hepatitis immunal globulin
• Avoiding over crouding

18. Hepatitis B
• Hepatitis B is an inflammatory liver disease
caused by the hepatitis B virus (HBV) which is a
DNA hepadevirus, that results in liver cell
damage.
• This damage can lead to scarring of the liver
(cirrhosis) and increased risk of liver cancer in
some people.

19. Mode of transmission
• HBV can be spread in the following ways:
By unprotected (without a condom) penetrative
sex (when the penis enters the anus, vagina or
mouth) with someone who is infectious. Also by
sex that draws blood with someone who is
infected.
By sharing contaminated needles or other drug-
injecting equipment.
By using non-sterilised equipment for tattooing,
acupuncture or body piercing.

20. Mode of transmission cont
From an infected mother to her baby, most commonly during
delivery. Immunisation of the baby at birth prevents the
transmission of hepatitis B.
Through a blood transfusion in a country where blood is not
INCUBATION PERIOD
• 4-24weeks

21. Phases of the infection
• This infection has 2 phases: acute and chronic.
 Acute (new, short-term) hepatitis B occurs shortly after exposure
to the virus. A small number of people develop a very severe, life-
threatening form of acute hepatitis called fulminant hepatitis.
 Chronic (ongoing, long-term) hepatitis B is an infection with HBV
that lasts longer than 6 months. Once the infection becomes
chronic, it may never go away completely.

22. Phases of the infection cont
 About 90-95% of people who are infected are able to fight off the
virus so their infection never becomes chronic.
 Only about 5-10 percent of adults infected with HBV go on to
develop chronic infection.

23. Pathophysiology
• Viral hepatitis causes diffuse inflammatory
infiltration of the hepatic tissue with mononuclear
cells, spotty or singular necrosis
• The liver may be swollen
• There is no collapse of lobules, no loss of lobular
architecture, and minimal or no fibrosis
• Inflammation and regeneration occur
simultaneously distorting the normal lobular pattern
and creating pressure within and around the portal
vein and obstruction the normal bile channel

24. Pathophysiology cont
• The pathological change in the hepatocytes is not always
related to the effect of the virus itself but rather the injurious
response of the body’s own immune system attempting to
clear out the virus
• The changes are associated with impaired liver functions

25. Signs and symptoms
• Half of all people infected with the hepatitis B virus have no
symptoms.
• Symptoms develop within 30-180 days of exposure to the
virus.
• The symptoms are often compared to flu.
• Most people think they have flu and never think about having
HBV infection.

26. Sign and symptoms cont
Appetite loss
Feeling tired (fatigue)
Nausea and vomiting
Itching all over the body
Pain over the liver (on the right side of the abdomen,
under the lower rib cage)
Fever
Jaundice - A condition in which the skin and the whites
of the eyes turn yellow in color
Urine becomes dark in color (like cola or tea).
Stools are pale in color (grayish or clay colored).

27. Drug-induced HEPATITIS
•Drug-induced hepatitis is an injury of
the liver due certain medicines.

28. • Causes
• The liver helps the body break down drugs
that one takes. However, if taken in over dose
or the process is slow liver can be damage.
• Some drugs can cause hepatitis with small
doses, even if the liver breakdown system is
normal. Large doses of many medicines can
damage a normal liver.
• Nonsteroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen, diclofenac, and
naproxen

29. • Other drugs that can lead to liver injury
include:
• Amiodarone
• Anabolic steroids
• Birth control pills
• Chlorpromazine
• Erythromycin
• Halothane (a type of anesthesia)

30. • Methyldopa
• Isoniazid
• Methotrexate
• Statins
• Sulfa drugs
• Tetracyclines
• Amoxicillin-clavulanate
• Some anti-seizure medicines
•

31. Symptoms
Symptoms may include
• Abdominal pain
• Dark urine
• Diarrhea
• Fatigue
• Fever
• Headache
• Jaundice
• Loss of appetite
• Nausea and vomiting
• Rash
• White or clay-colored stools

32. • Exams and Tests
• LFT Liver enzymes will be higher
• Physical exam to check for an enlarged
liver and abdominal tenderness in the
right upper part of the abdomen .
• A rash or fever may be part of some drug
reactions that affect the liver.

33. Fulminant hepatitis
• Fulminant hepatitis is an unusual illness. It is
a severe form of acute hepatitis that can be
life threatening if not treated right away.
• Severe hepatic failure with development of
hepatic encephalopathy within 8/52 due to
any cause.
• 70% are due to acute viral hepatitis
• Other causes are drugs, shock, malignancy(
commonly lymphoma), wilson’s disease, fatty
liver of pregnancy
•

34. • The symptoms develop very suddenly.
Mental disturbances such as confusion,
lethargy, extreme sleepiness or
hallucinations (hepatic encephalopathy)
Sudden collapse
Jaundice
Swelling of the abdomen

35. Sign and symptoms cont
•Prolonged nausea and vomiting can
cause dehydration. If Patient has been
vomiting repeatedly, you may notice
these symptoms:
Feeling tired or weak
Feeling confused or having difficulty
concentrating
Headache
Not urinating
Irritability

36. Sign and symptoms cont
• Symptoms of liver failure may include the
following:
Fluid retention causing swelling of the
belly (ascitis) and sometimes the legs
Weight gain due to ascitis
Persistent jaundice Loss of appetite,
weight loss, wasting

37. Vomiting with blood in the vomit
Bleeding from the nose, mouth, or
rectum or blood in the stool
Hepatic encephalopathy (excessive
sleepiness, mental confusion, and in
advanced stages, development of
coma

38. Management
• Supportive treatment.
• Hepatic encephalopathy
Restrict protein intake
Metrinidazole
Lactulose 30 ml 6hourly
• Cerebral oedema
Major cause of death- when signs of
increased ICP are present give mannitol

39. • Nutritional
10% dextrose
RBS checked every 2 hour due to
hypoglyceamia
Correct electrolytes eg K and ca
• Cardiovascular functions
I/V infusion of fluid, colloid or blood
Regular BP, pulse, urine out put checks

40. • Hemorrhage
Failure of coagulation factors will lead to
bleeding esp. in GIT
Give iv vit K, platelets, blood
Ranitidine iv given to prevent GI bleeding
• Infection
Broad spectrum antibiotic if suspected

41. • Renal failure
Dailysis
• Acetylcysteine
Known to improve cerebral blood flow in
all pts with FHF due to any cause.
• Liver transplatation
Considered for pts with stage II to III
encephalopathy.

42. Complications of FHF
• Encephalopathy
• Cerebral edema
• Respiratory failure
• Hypotension
• Hypothermia
• Infection
• bleeding

43. • Pancreatitis
• Renal failure
Hypoglycaemia
Hypokalemia
Hypocalcemia
Hypomagnesemia

44. Toxic hepatitis
•Toxic hepatitis is an inflammation of
the liver in reaction to certain
substances to which the patient was
exposed. It may develop hours or
days or even months after the
exposure to a toxin.

45. Causes
• Alcohol. Heavy drinking over many years.
• DRUGS such as aspirin, ibuprofen (Advil,
Motrin IB, others) and naproxen phenytoin
(Dilantin, Phenytek), azathioprine (Azasan,
Imuran), niacin (Niaspan), ketoconazole,
certain antivirals and anabolic steroids.
• Herbs and supplements
• Industrial chemicals group of industrial
chemicals called polychlorinated
biphenyls., herbicide paraquat

46. • Risk factors
• Factors that may increase your risk of toxic
hepatitis include:
• Taking over-the-counter pain relievers or
certain prescription drugs.
• Liver disease. Having a serious liver disorder
such as cirrhosis or nonalcoholic fatty liver
disease
• Having hepatitis.
• Aging.
• Drinking alcohol. .

47. • Having certain genetic
mutations. Inheriting certain genetic
mutations that affect the production and
action of the liver enzymes that break
down toxins may make you more
susceptible to toxic hepatitis.
• Working with industrial toxins. Working
with certain industrial chemicals puts you
at risk of toxic hepatitis.
•

48. • Symptoms
• Jaundice
• Itching
• Abdominal pain in the upper right portion of the abdomen
• Fatigue
• Loss of appetite

49. • Nausea and vomiting
• Rash
• Weight loss
• Dark or tea-colored urine

50. Diagnosis
• History to assess the likelihood of hepatitis B
infection.
• Clinical picture will demonstrate jaundice.
• Confirm the diagnosis of hepatitis B with
appropriate laboratory testing. IgM anti body to
HBV
• Use serologic testing to exclude HBV infection in
persons with unexplained acute liver failure.
Blood to r/o hepatitis A and C
• liver function (laboratory evaluation of: urine
bilirubin and urobilinogen, total and direct
serum bilirubin, ALT and/or AST alkaline
phosphatase, prothrombin time, total protein,
albumin, IgG, IgA, IgM
• Hepatic scan may show inflammation

51. Treatment
• Acute hepatitis B usually goes away by itself and does not
require medical treatment.
• There are no medications that can prevent acute hepatitis B
from becoming chronic
• Glucose to promote rest of the liver there by promoting
recovery
• Vitamin B complex 2 tablets
• Vitamin A 200000iu
• Prednisolone 30mg od for 14/7 then reduce till you stop
• Analgesics for pain e.g. panadol 500mg tds for 3/7

52. Treatment cont
• The most severe effect of acute hepatitis B is
dehydration from vomiting and diarrhea.
• If you are dehydrated, your doctor may prescribe
IV fluid such as Ringer’s lactate 2000ml in 24
hours.
• If patient is experiencing significant nausea and
vomiting anti emetics will be given e.g.
phenegan 10mg.
• There is no treatment that can prevent acute
HBV infection from becoming chronic

53. Disease out come
Either you develop immunity to HBV
• 95% of adults infected develop antibodies and
recover spontaneously within six months.
• Upon recovery, they develop immunity to the
virus and they are not infectious to others.
• Blood tests will always test positive for the HBV
antibody.
• Blood banks will not accept donations of blood
from HBV-immune people.

54. Disease out come
OR you become chronically infected.
• About 5% of the time, the virus does not clear
the body within six months.
• If so, a person is considered a carrier – or
chronically infected.
• Chronically infected people may or may not
show outward signs or symptoms.
• The HBV virus remains in blood and body fluids,
and can infect others.

55. Prevention
• Practice safe sex (use latex condoms).
• Don't share anything that could have an infected person's
blood on it, i.e. toothbrushes, razors, nail clippers, body
piercing instruments.
• Don't share drug needles, cocaine straws or any drug
paraphernalia.

56. Prevention
• Cover all sores and rashes and do not touch
them.
• Clean up any blood spills with a 10% solution of
household bleach. Infected persons should not
pre-chew food for babies.
• If exposed to hepatitis B, get an HBIG (hepatitis
B immune globulin) injection within 14 days
following exposure.
• Vaccination against hepartitis

57. Hepatitis C
• It is the inflammation of the liver that is caused
by Hepatitis C virus. Hepatitis C virus a member
of the Flaviviridae family of viruses which are
RNA viruses
• Mode of transmission: The hepatitis C virus
(HCV) usually is spread by
 shared needles among drug abusers,
 blood transfusion,
 hemodialysis, and
needle sticks
Un protected sex with an infected person

58. Signs and symptoms
• At the beginning of an hepatitis C virus infection, only about
25% of patients exhibit the characteristic symptoms of acute
(rapid onset) hepatitis.
• These symptoms include;
 fatigue,
muscular aches,


59. Signs and symptoms cont
poor appetite, and
low-grade fever.
Rarely, yellowing of the skin and/or eyes (jaundice) also
occurs.
However, most patients (about 75%) experience minimal or no
symptoms at the onset of hepatitis C virus.

60. Dianonosis
• As for other form of viral hepatitis
• Additionally do Blood for HCV antibodies

61. Progressionof chronichepatitisC virus
• Our understanding of the natural progression
(history) of hepatitis C infection is still evolving.
• About 15% of patients with acute hepatitis C
virus infection spontaneously recover (clear the
virus).
• 85%, however, develop chronic liver disease.
• Patients with chronic hepatitis C infection are at
risk for developing cirrhosis, liver failure, and
liver cancer

62. Treatment
• As for hepatitis B
• Prevention as for hepatitis B

63. Toxic hepatitis
• The inflammation of the liver caused by toxic
agent.
• The toxic agent may include:
Drugs like acetaminophen, pyrazinamide, etc
Alcohol
Industrial toxins such as carbon tetrachloride
from dry cleaning agents. Insecticides.
Plant poisons like mushroom, and bush teas

64. Treatment
• Identify and remove the damaging agent e.g. by gastric lavage
• Where there is a known treatment for the poison it may be
given
• For instance for Acetaminophen over dose, Acetyl cysteine will
be given

65. Complications of hepatitis
• Chronic hepatitis
• Hepatic coma
• Liver cirrhosis
• Cancer of the liver
• Acute hepatic necrosis

66. Hepatitis D
• It is a type of viral hepatitis that is caused by hepatitis D virus
which is caused by a defective RNA virus that needs the helper
function of HDV co-infection
• It needs the presence of HBV to replicate
• Can not occur on its own.

67. Nursing care
• AIMS:
To promote optimal functioning of the liver and prevent
spread of the infection
Improve patient’s knowledge about the condition
Alley anxiety

68. Environment
• Patient will be nursed in an isolation ward but to
prevent infection spread
• Patient will be nursed in a well ventilated room
to prevent nosocomial infection and promote
comfort
• Patient will be nursed in a well lit room for easy
observation and for orientation to time and
place
• I will include the drip stand in the room for IVI
when need arises

69. Position
• Patient will be nursed in fowlers position to promote lung
expansion and relieve dyspnea
• I will change the patient’s position two hourly to prevent
development of pressure sores
• As the condition improves I will let the patient adopt any
position of comfort to promote rest

70. Rest
• I will play the radio at low volume to promote
rest
• I will answer all phone calls promptly to prevent
disturbing the patient there by promote rest
• I will do related procedures in blocks to promote
rest
• I will administer prescribed analgesics in order to
relieve pain thereby promoting rest
• I will ensure that squeaking trolleys a oiled to
prevent noise and there by promote rest

71. Observations
• I will do vital sign and BP to act as the base line
data in order to know if the condition is
improving or deteriorating
• I will observe jaundice if improving or getting
worse
• I will observe for the itching if present I will offer
ant histamines
• I will observe the pressure area to detect on set
of pressure sore development

72. Observations
• I will observe the stool and urine for colour and
note any improvement towards normal report
the physician
• I will observe the patient’s facial expressions to
detect pain and administer prescribed analgesics
like panadol
• I will observe the feeding pattern of my patient
and take measures like giving small frequent
meals to promote appetite
• I will observe the respirations to detect
tachycardia and report accordingly

73. Psychological support
• I will explain the disease process in order to raise
the knowledge levels and thereby alley anxiety
• I will encourage the patient to ask question and I
will answer accordingly those I cant answer I will
refer to the physician in order to clear
misconceptions thereby allaying anxiety
• I will explain all procedures to my patient in order to
allay anxiety and gain cooperation.
• I will involve a successfully managed case to come
and talk to my patient in order to allow the patient
ask pressing question and get answer this will
improve the patients out look on his condition

74. Psychological support cont
• I will explain the reason for isolation to alley
anxiety
• I will provide diversional therapy in order to shift
the patient’s mind from the hospital routine and
his condition
• I will involve him in planning his own care in
order for him not to feel left out
• I will explain to him that as the health care team
we are doing everything possible to ensure that
he get better in order to promote co-operation

75. Hygiene
• I will encourage the patient to take plunge baths
in order to remove dead epithelium and
promote comfort
• I will do hair care to promote self esteem and
also prevent pediculosis
• I will do nail care to prevent auto infection
• I will do mouth care to prevent halitosis
• Any soiled linen and clothes will be changed to
promote comfort

76. Elimination
• I will provide privacy if my patient asks for a bed pan in order
to promote bowel motions
• I will prove copious fluids in order to promote renal wash out
and there by prevent renal problems
• I will offer a bed pan if he is confined to bed to ensure bowel
movement

77. Nutrition
• I will provide energy giving foods like inshima to
provide the energy needed for the metabolic
processes and promote recovery of the liver.
• I will provide protein foods like fish and beans to
promote replacement of worn out tissues
• Vegetables and fruits will be provided to raise
the immunity and promote skin and mucous
membrane integrity

78. Nutrition cont
• I will provide a lot of oral fluids to prevent dehydration due to
excessive sweating and promote bringing up of phlegm
• I will serve small frequent meals to promote appetite
• I will do regular mouth washes in order to promote appetite

79. Activity
• If my patient is confined to bed i will do passive
exercises like limb movement and massage in
order to prevent muscle atrophy and promote
blood circulation
• I will encourage the patient to do deep
breathing exercises in order to promote lung
expansion
• I will encourage early ambulation as soon as the
condition permits in order to prevent deep vein
thrombosis and other complications of
immobility

80. Medication
• I will administer prescribed analgesic like panadol at the right
time to promote rest
• I administer prescribe fluids to prevent dehydration
• I will ensure that the drugs are swallowed in my presence to
promote recovery.

81. Health education
• I will educate the patient about his condition in
order to create awareness and prevent
recurrence of the condition
• I will explain the need for taking the medication
in order to promote compliance
• I will educate the patient about the sign and
symptoms of the condition for early diagnosis
and treatment I will educate the patient about
the need keep the review dates so that his
progress is monitored to ensure full recovery

82. Health education cont
• I will advise the patient to avoid over crowding to prevent
spread of infection
• I will talk to the patient about the need to take a balanced diet
using locally available foods in order to boost the immunity

83. THE END
THANK
YOU!
LC
83