Hepatitis A and B Overview Quiz

Hepatitis Overview

• Hepatitis is liver inflammation
• Viral hepatitis is the most common cause
• Other causes include drugs (alcohol, chemicals), autoimmune diseases, and metabolic abnormalities

Viral Hepatitis Types

• Types A, B, C, D, and E are the main viral types
• Note: Focus on A, B, and C in this study guide.

Hepatitis A Virus (HAV)

• Ranges from mild to acute liver failure
• Not a chronic disease
• Incidence decreased with vaccination
• RNA virus, transmitted via the fecal-oral route
• Associated with contaminated food or water

Hepatitis B Virus (HBV)

• Can cause acute or chronic disease
• Incidence decreased with vaccination
• DNA virus
• Transmitted perinatally and percutaneously, meaning from mother to child, and through cuts/open sores/blood entry points
• Exposure includes infectious blood, blood products, or other body fluids

Hepatitis B Virus (HBV) - At-Risk Populations

• Men who have sex with men
• Household contacts of chronically infected individuals
• Patients undergoing hemodialysis
• Healthcare workers
• Transplant recipients

Hepatitis C Virus (HCV)

• Can be acute (asymptomatic) or chronic (liver damage)
• RNA virus, transmitted percutaneously
• Risk factors include IV drug use, high-risk sexual behaviors, occupational exposure, dialysis, and perinatal exposure

Hepatitis D Virus (HDV)

• Also known as delta virus
• Defective single-stranded RNA virus
• Cannot survive without HBV
• Transmitted percutaneously
• No vaccine available

Hepatitis E Virus (HEV)

• RNA virus, transmitted via the fecal-oral route
• Typically associated with contaminated water
• Commonly encountered in developing countries
• Few cases in developed countries, like the United States

Pathophysiology

• Acute infection: widespread destruction of hepatocytes (liver cells)
• Liver cells regenerate in a normal form after infection resolution
• Chronic infection: can cause fibrosis and progress to cirrhosis
• Antigen-antibody complexes activate the complement system, leading to systemic manifestations including rashes, angioedema, arthritis, fever, and malaise.

Hepatitis Case Study

• A 30-year-old man (A.M.) was admitted to the hospital with fatigue, lack of appetite, headaches, and jaundice.
• Symptoms progressed over a few days.
• One month prior, he was in Mexico and consumed a lot of seafood and local foods.
• He also reported having sex with a prostitute in Mexico.
• The health care provider suspected acute Hepatitis A

Clinical Manifestations

• Acute and chronic hepatitis
• Many patients are asymptomatic
• Symptoms can be intermittent or ongoing, including malaise, fatigue, myalgias/arthralgias, and right upper quadrant tenderness
• Acute phase: symptoms during incubation, anorexia, lethargy, weight loss, fatigue, nausea/vomiting, and RUQ tenderness; distaste for cigarettes
• Physical examination: hepatomegaly, lymphadenopathy, and splenomegaly, dark/clay-colored stools, jaundice, pruritus, and possible low-grade fever
• Convalescent phase: begins when jaundice disappears, lasting weeks to months, major complaints include easy fatigability and persistent hepatomegaly

Recovery

• Most acute Hepatitis A patients fully recover without complications.
• Some cases of HBV and most HCV cases result in chronic hepatitis.

Complications

• Acute liver failure (potentially fatal) can be a complication.
  • Fulminant hepatic failure: severe form of acute liver failure
  • Encephalopathy, gastrointestinal bleeding, and disseminated intravascular coagulation are possible manifestations
• Chronic hepatitis B and C: are complications that can lead to cirrhosis, portal hypertension, and hepatocellular carcinoma.
• Other possible complications include cirrhosis, portal hypertension, and hepatocellular carcinoma

Diagnostic Studies

• HAV IgM, anti HAV IgG
• HBsAg, anti HBs, HBeAg, anti HBe, anti HBc IgM, anti HBc IgG, HBV DNA
• Anti HCV, HCV RNA
• Anti HDV, HDV Ag
• Liver function tests
• Viral genotype testing
• HBV
• HCV
• Physical assessment
• Liver biopsy
• FibroScan and/or FibroSure (FibroTest)

Case Study - Laboratory Results

• Hemoglobin 12 g/dL
• Bilirubin (direct) 5.6 mg/dL
• Bilirubin (indirect) 3.4 mg/dL
• Alkaline Phosphatase 600 U/mL
• AST 1200 U/mL
• ALT 1510 U/mL
• Urine positive for bilirubin
• Anti HAV IgM positive
• Anti HAV IgG negative
• HBsAg negative
• Anti HBs negative
• Anti HCV negative
• Anti HDV negative

Interprofessional Care

• Acute and chronic: Adequate nutrition, well-balanced diet, vitamin supplements, rest (with degree of strictness that varies per patient), avoid alcohol and drugs detoxified by the liver, notification of possible contacts
• Acute HAV, no specific drug therapy
• Acute HBV, drug therapy needed if severe
• Acute HCV, pegylated interferon or DAAs used. Supportive drug therapy, antihistamines & antiemetics
• Chronic Hepatitis B: decrease viral load, liver enzyme levels, disease progression, prevent complications (cirrhosis, portal hypertension, liver failure, cancer)
• Drug therapy needed for both hepatitis B and C infections (various drugs)
• Nutritional therapy: well balanced diet, adequate calorie intake in acute infections, vitamins (complex and K) may be important; fluid & electrolyte balance

Nursing Assessment

• Subjective data—medical history (including allergies, prior infection, current medications, habits), exposure to infected persons, ingested foods, blood transfusions, other risk factors
• Functional health patterns—iv drug & alcohol use, distaste for cigarettes (in smokers), high risk sexual behaviors, weight loss, anorexia, abdominal discomfort, change in urine/stool color, fatigue, arthralgias/myalgias, and exposure to high-risk groups
• Objective data—low-grade fever, jaundice, rash, hepatomegaly, splenomegaly, abnormal lab values/findings/results

Nursing Diagnoses

• Imbalanced nutrition less than body requirements
• Activity intolerance
• Risk for impaired liver function

Planning

• Patient will have relief of discomfort
• Resumption of normal activities
• Normal liver function without complications

Hepatitis Transmission Prevention

• Active immunization (vaccination)
• Post exposure prophylaxis (PEP) if exposure occurs in healthcare personnel
• General measures (avoiding contaminated food/water, proper hygiene, sanitation etc.)

Hepatitis A

• Etiology: Fecal oral route
• Pathophysiology: Primarily inflammation of liver tissue
• Mode of transmission: Fecal contamination and oral ingestion, especially in individuals in high-risk populations or outbreaks; found in the feces from 2 or more weeks before the onset of symptoms to up 1 week after the onset of jaundice
• Detection: Presence of HAV IgM antibodies are indicative of acute infection
• Clinical manifestations: Acute, mild/asymptomatic, including malaise, anorexia, fatigue, nausea, vomiting, right upper quadrant discomfort, jaundice, and possible low-grade fever
• Interventions: Adequate nutrition, comfort measures, assessment for Jaundice, comfort measures, physical rest & emotional rest, diversion activities
• Complications: Acute liver failure

Nursing Implementation and Evaluation

• Patient education and follow-up
• Avoidance of alcohol and hepatotoxic agents

Key entities

• HAV, IgG, IgM, HBV, HCV, HDV, HCV, liver cells, etc