Hepatitis A and B Overview Quiz
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Questions and Answers

What is the most common cause of hepatitis?

  • Autoimmune disease
  • Bacterial infection
  • Alcohol abuse
  • Viral infection (correct)
  • How is Hepatitis A primarily transmitted?

  • Sexual contact
  • Blood transfusion
  • Fecal-oral route (correct)
  • Airborne droplets
  • When is a person with Hepatitis A most infectious?

  • During the icteric phase
  • During the prodromal phase
  • During the incubation period (correct)
  • During recovery
  • Which of the following is NOT a characteristic of Hepatitis A?

    <p>Transmitted through blood (B)</p> Signup and view all the answers

    Which of these is a potential source of Hepatitis A infection?

    <p>Contaminated food (A)</p> Signup and view all the answers

    What type of cells cause liver damage in Hepatitis A?

    <p>Natural killer cells (B)</p> Signup and view all the answers

    What is the duration of infectivity for Hepatitis A?

    <p>The entire course of the illness (D)</p> Signup and view all the answers

    Which of these is a preventative measure for Hepatitis A?

    <p>Vaccination (D)</p> Signup and view all the answers

    Which of the following clinical manifestations can be observed during the physical examination of a patient with acute Hepatitis B?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary focus of drug therapy for Hepatitis B?

    <p>Decrease viral load and liver enzyme levels (A)</p> Signup and view all the answers

    Which of the following is NOT a complication of Hepatitis B?

    <p>Hepatic encephalopathy (A)</p> Signup and view all the answers

    What is the significance of genotyping in Hepatitis B?

    <p>Predicting disease outcomes and therapeutic interventions (A)</p> Signup and view all the answers

    Which of the following is a subjective data point that can be collected during the nursing assessment of a patient with Hepatitis B?

    <p>History of IV drug use (A)</p> Signup and view all the answers

    Which of the following is a first-line therapy for Hepatitis B?

    <p>Entecavir (C)</p> Signup and view all the answers

    Which of the following aspects is NOT considered essential in the collaborative care of a Hepatitis B patient?

    <p>Antibiotics (C)</p> Signup and view all the answers

    What is the period of maximum infectivity for a patient with Hepatitis B?

    <p>Acute phase (B)</p> Signup and view all the answers

    Based on the laboratory results, which type of hepatitis does A.M. have?

    <p>Hepatitis A (C)</p> Signup and view all the answers

    Which of the following is a likely mode of transmission for A.M.'s hepatitis infection?

    <p>Contaminated food or water (C)</p> Signup and view all the answers

    Which of these laboratory results indicates liver damage in A.M.?

    <p>Urine positive for bilirubin (A), Alkaline phosphatase 600 U/mL (D)</p> Signup and view all the answers

    What is the significance of a positive anti-HAV IgM result?

    <p>A current infection with Hepatitis A (B)</p> Signup and view all the answers

    Why is it important for the healthcare provider to investigate possible contacts of A.M.?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of these interventions is NOT typically recommended for A.M.'s hepatitis?

    <p>Antiviral medication (A)</p> Signup and view all the answers

    Which of these tests would be LEAST relevant for diagnosing A.M.'s current condition?

    <p>HBeAg (D)</p> Signup and view all the answers

    Which of these laboratory values is most likely to be elevated in someone with Hepatitis A?

    <p>Bilirubin (C)</p> Signup and view all the answers

    What is a common symptom associated with acute hepatitis C infection?

    <p>Fatigue (C)</p> Signup and view all the answers

    Which of the following is NOT a common mode of transmission for hepatitis C virus?

    <p>Gastrointestinal contact (B)</p> Signup and view all the answers

    What is the typical duration of the acute hepatitis C phase?

    <p>1-4 months (C)</p> Signup and view all the answers

    Which of the following is a potential complication of chronic hepatitis C infection?

    <p>Liver cirrhosis (D)</p> Signup and view all the answers

    What is the most common clinical manifestation of hepatitis C, especially in individuals with long-term infections?

    <p>Jaundice (D)</p> Signup and view all the answers

    What is the primary mechanism of liver damage in acute hepatitis C infection?

    <p>Immune response (C)</p> Signup and view all the answers

    How is jaundice associated with hepatitis C infection?

    <p>Accumulation of bilirubin in the blood (D)</p> Signup and view all the answers

    What is the typical progression of the convalescent phase following acute hepatitis C infection?

    <p>Gradual improvement with lingering fatigue and potential hepatomegaly (C)</p> Signup and view all the answers

    What is the recommended treatment for acute viral hepatitis?

    <p>No specific treatment or therapy exists (B)</p> Signup and view all the answers

    What percentage of individuals with HCV will develop cirrhosis over 20-30 years?

    <p>5%-50% (D)</p> Signup and view all the answers

    Which of the following is NOT a possible complication of HCV?

    <p>HIV infection (C)</p> Signup and view all the answers

    What is the primary purpose of HCV RNA testing?

    <p>To assess for chronic HCV infection (A)</p> Signup and view all the answers

    Which of the following factors is a strong predictor of response to HCV therapy?

    <p>Genotype of HCV (B)</p> Signup and view all the answers

    What does the presence of anti-HCV antibodies indicate?

    <p>A potential for chronic HCV disease (A)</p> Signup and view all the answers

    What is the significance of genotyping HCV in patients with positive HCV antibody tests?

    <p>To identify the specific treatment needed (C)</p> Signup and view all the answers

    What is the main rationale for bed rest in patients with acute viral hepatitis?

    <p>To allow the body to focus on fighting the infection (B)</p> Signup and view all the answers

    What is the recommended time frame for administering the second dose of the hepatitis B vaccine?

    <p>Within one month of the first dose (A)</p> Signup and view all the answers

    According to the information provided, how effective is the hepatitis B vaccine in preventing infection?

    <p>95% (C)</p> Signup and view all the answers

    What is the recommended fluid intake for a patient with hepatitis B?

    <p>2500-3000 mL/day (A)</p> Signup and view all the answers

    A client with hepatitis B is being discharged home. Which of the following instructions should the nurse include in the discharge plan to help prevent the spread of the virus?

    <p>Wash hands frequently (A)</p> Signup and view all the answers

    What is the recommended dietary approach for a client with hepatitis B?

    <p>Well-balanced diet (C)</p> Signup and view all the answers

    What is the recommended treatment for post-exposure prophylaxis of hepatitis B?

    <p>Hepatitis B immune globulin (HBIG) and hepatitis B vaccine (D)</p> Signup and view all the answers

    What kind of diet is recommended for a client hospitalized with viral hepatitis?

    <p>Bland diet (A)</p> Signup and view all the answers

    A client with chronic hepatitis B should avoid what to prevent disease progression?

    <p>Alcohol (A)</p> Signup and view all the answers

    Flashcards

    Ambulatory Care

    Outpatient care provided to patients who do not require hospitalization.

    Hepatitis A

    Inflammation of the liver caused by the Hepatitis A virus, typically transmitted through fecal-oral route.

    Transmission Prevention

    Methods taught to patients to avoid spreading Hepatitis A, including hygiene and food handling.

    Incubation Period of Hepatitis A

    The time between exposure to the virus and the onset of symptoms, averaging 28 days.

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    Infectivity of Hepatitis A

    Most infectious two weeks before symptoms appear and one to two weeks after symptoms start.

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    Sources of Hepatitis A Infection

    Transmission sources include poor hygiene, contaminated food, and crowded conditions.

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    Medication Education for Hepatitis

    Teaching patients about administering interferon and understanding its side effects.

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    Nutritional Needs in Hepatitis Care

    Maintaining adequate food and fluid intake to support liver function during Hepatitis.

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    Acute vs Chronic Hepatitis

    Acute hepatitis is short-term, while chronic persists for 6 months or more.

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    Symptoms of Acute HBV

    Can be asymptomatic in 30% of cases; maximal infectivity occurs during this phase.

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    Complications of Hepatitis

    Includes fulminant hepatic failure, chronic hepatitis, cirrhosis, and hepatocellular carcinoma.

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    Liver Function Tests

    Show significant abnormalities indicative of liver damage.

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    Genotypes of HBV

    At least 8 different types (A to H) used to predict disease outcomes.

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    Collaborative Care

    Includes well-balanced diet, vitamin supplements, rest, and avoiding liver toxins.

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    First Line Therapies for HBV

    Include Pegylated α-interferon, Entecavir, and Tenofovir to reduce viral load and liver damage.

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    Hepatomegaly

    Enlargement of the liver, often due to disease.

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    Splenomegaly

    Enlargement of the spleen, can indicate infection.

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    Icteric Urine

    Urine that appears yellow due to bilirubin.

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    Anti-HAV IgM

    Antibody indicating recent Hepatitis A infection.

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    Hepatitis B Tests

    Includes HBsAg, anti-HBs, and more for diagnosing HBV.

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    Nutritional Interventions

    Emphasizes a balanced diet and vitamin supplements.

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    Hepatitis A Transmission

    Spread through contaminated food or water.

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    Vaccine Dosing Schedule

    The second dose of HBV vaccine should be given within one month of the first, and the third dose six months after the second.

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    Vaccine Effectiveness

    The HBV vaccine is effective in 95% of cases.

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    Post-Exposure Prophylaxis

    HBV vaccine and hepatitis B immune globulin (HBIG) are used for post-exposure prophylaxis.

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    Jaundice Assessment

    Assessing for the presence and degree of jaundice is important in hepatitis patients.

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    Nutrition in Hepatitis

    Patients should eat small, frequent meals to avoid nausea and ensure nutrition.

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    Fluid Intake Recommendation

    Patients with hepatitis should maintain a fluid intake of 2500-3000 mL/day.

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    Alcohol and Chronic HBV

    Patients with chronic HBV should avoid alcohol to prevent disease progression.

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    Family Vaccination Importance

    Family members should be educated about hepatitis and vaccination; unnecessary vaccination for all.

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    Liver Complications of HCV

    HCV can lead to liver cirrhosis, liver cancer, and fulminant hepatic failure.

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    Mortality Rate of HCV

    The mortality rate from HCV is less than 1%, but 1%-5% may die from complications like cirrhosis or cancer.

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    Initial Testing for HCV

    Initial testing includes HCV antibody testing; if positive, HCV RNA testing follows to check for chronic infection.

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    Anti-HCV Antibody Test

    An immunoassay to detect antibodies; a positive result requires further confirmatory testing.

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    Role of HCV Genotyping

    Genotyping HCV helps predict therapy response and treatment duration.

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    Symptoms during Physical Assessment

    Physical signs include hepatic tenderness, hepatomegaly, splenomegaly, and a palpable liver.

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    Drug Therapy for Acute HCV

    There is no specific treatment for acute HCV, but pegylated interferon may decrease chronic hepatitis risk if given early.

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    Management of Acute Viral Hepatitis

    Most patients can be managed at home with rest and nutrition; no specific therapy required.

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    Etiology of Hepatitis C

    RNA virus primarily transmitted percutaneously through blood or sexual contact.

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    Mode of Transmission

    Includes sharing contaminated needles, blood transfusions, sexual activities, and perinatal contact.

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    Acute Infection Effects

    Liver damage mediated by cytotoxic cytokines and natural killer cells leading to necrosis and inflammation.

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    Clinical Manifestation

    Symptoms can be classified as acute or chronic, with malaise, fatigue, and nausea common in acute phase.

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    Acute Hepatitis Symptoms

    Symptoms include malaise, anorexia, nausea, and right abdominal discomfort lasting 1-4 months.

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    Jaundice Indicators

    Jaundice occurs when bilirubin diffuses into tissues causing dark urine and clay-colored stools.

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    Convalescent Phase

    Begins as jaundice disappears; symptoms of malaise and easy fatigue persist for weeks to months.

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    Chronic Hepatitis C Risk

    75%-85% of those with HCV develop chronic infection, which can lead to further complications.

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    Study Notes

    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

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    Description

    Test your knowledge on Hepatitis A and B with this comprehensive quiz. Explore topics such as transmission, infection characteristics, and treatment options. Understand the preventative measures and clinical manifestations associated with these infections.

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