Hepatitis

Introduction:

Hepatitis is an inflammation of the liver cells. This is most commonly due to a
viral cause which may be either an acute illness or become chronic. The disease
may also be due to exposure to drugs or toxins.
Hepatitis A is transmitted via an oral route, often due to contaminated water or
poor sanitation when traveling; it is also transmitted in daycare settings and resi-
dential institutions. It can be prevented by vaccine.
Hepatitis B is transmitted via a percutaneous route, often due to sexual contact,
IV drug use, mother-to-neonate transmission or possibly blood transfusion. It can
be prevented by vaccine.
Hepatitis C is transmitted via a percutaneous route, often due to IV drug use or,
less commonly, sexual contact. There is currently no vaccine available.
Hepatitis D is transmitted via a percutaneous route and needs hepatitis B to
spread cell to cell. There is no vaccine available for hepatitis D.
Hepatitis E is transmitted via an oral route and is associated with water con-
tamination. There is no known chronic state of hepatitis E and no current vaccine
available.
Hepatitis G is transmitted via a percutaneous route and is associated with chronic
infection but not significant liver disease.
Exposure to medications (even at therapeutic doses), drugs, or chemicals can
also cause hepatitis. Onset is usually within the first couple of days of use, and may
be within the first couple of doses. Hepatotoxic substances include acetamino-
phen, carbon tetrachloride, benzenes, and valproic acid.


PROGNOSIS

Hepatitis may occur as an acute infection (viral type A, E) or become a chronic
state. The patient with chronic disease may be unaware of the illness until testing
of liver function shows abnormalities and further testing reveals presence of hep-
atitis. The chronic (viral type B, C) disease state creates the potential development
of progressive liver disease. Some patients with chronic disease will need liver
transplant. Recurrence rate post-transplant is high. Liver cancer may develop in
those with chronic disease states.

SIGNS AND SYMPTOMS

• Acute hepatitis:
• Malaise
• Nausea and vomiting
• Diarrhea or constipation
• Low-grade fever
• Dark urine due to change in liver function
• Jaundice due to liver compromise
• Tenderness in right upper quadrant of abdomen
• Hepatomegaly
• Arthritis, glomerulonephritis, polyarteritis nodosa in hepatitis B
• Chronic hepatitis:
• Asymptomatic with elevated liver enzymes
• Symptoms as acute hepatitis
• Cirrhosis due to altered liver function
• Ascites due to decrease in liver function, increased portal hypertension
• Bleeding from esophageal varices
• Encephalopathy due to diminished liver function
• Bleeding due to clotting disorders
• Enlargement of spleen


TREATMENT
• Avoid medications metabolized in the liver.
• Avoid alcohol.
• Remove or discontinue causative agent if drug-induced or toxic hepatitis.
• Intravenous hydration if vomiting during acute hepatitis.
• Activity as tolerated.
• High-calorie diet; breakfast is usually the best tolerated meal.
• Administer interferon or lamivudine for chronic hepatitis B.
• Administer interferon and ribavirin for hepatitis C.
• Administer prednisone in autoimmune hepatitis.
• Liver transplantation.

NURSING DIAGNOSES

• Fatigue
• Risk for injury
• Impaired tissue integrity

NURSING INTERVENTION

• Monitor vital signs.
• Assess abdomen for bowel sounds, tenderness, ascites.
• Plan appropriate rest for patient in acute phase.
• Monitor intake and output.
• Assess mental status for changes due to encephalopathy.
• Assist patient to:
• Plan palatable meals; remember that breakfast is generally the best toler-
ated meal.
• Avoid smoking areas—intolerance to smoking.