3 Commmon communcable diseases affecting the Gastointestinal System Final-1.pptx

Common Communicable Diseases affecting the Gastrointestinal System Prepared by : Dr. Irynne D. Cabanban Typhoid Fever / Enteric Fever Risk Factors: https://www.youtube.com/watch?v=7jo3s ut_9ok Causative Agent: Salmonella typhosa, Salmonella paratyphi Incub...

Common Communicable Diseases affecting the Gastrointestinal System Prepared by : Dr. Irynne D. Cabanban Typhoid Fever / Enteric Fever Risk Factors: https://www.youtube.com/watch?v=7jo3s ut_9ok Causative Agent: Salmonella typhosa, Salmonella paratyphi Incubation Period: 7 -14 days Period of Communicability: The period of communicability is variable. As long as the patient is excreting the microorganism, he is capable of infecting others. Source of Infection: Feces, urine and vomitus of infected person A person who has just recovered from the disease or has recently taken care of a patient with typhoid and was infected is considered a potential carrier. Ingestion of shellfish (oysters) taken from waters contaminated with sewage disposal can be a source of infection. Mode of Trasmission: The disease can be passed from one person to another through fecal- oral transmission. The organism can be transmitted through the 5 Fs. The disease can be transmitted through the ingestion of contaminated food, water and milk. Signs and Symptoms: 1. Prodromal Stage headache, fever, anorexia, lethargy, diarrhea or constipation, vomiting, abdominal pain, feeling of unwellness 2.) Fastigial Stage / Pyrexial Stage : the following signs appear: a.) ladder like curve of tempt. b.) splenomegaly ▪c.) Rose spots (Pathognomonic sign of Typhoid fever) -Groups of 5-15 pink blanching papules (little bumps) appear on the anterior trunk, usually occur between the second and fourth week of illness. ▪d. Typhoid state or “Typhoid psychosis” ▪Typhoid State include : 1. Symptoms decline in severity. 2. The tongue protrudes, becoming dry and brown. 3. Teeth and lips accumulate a dirty-brown collection of dried mucus and bacteria known as sordes (preventable by good nursing care). 4. Patient seems to be staring blankly (coma vigil). 5. Twitching of the tendons sets in, especially those of the wrist (subsultustendinum). 6. Patient mutters deliriously and picks up aimlessly at bedclothes with his fingers in a continuous fashion (carphologia). 7. There is a constant tendency for the patient to slip down to the foot part of the bed. 8. In severe cases rambling delirium sets in, often ending in death. 3. Defervescent stage fever gradually subsides severity of previous conditions ,onset of complications COMPLICATIONS 1. Hemorrhage or perforation - the two most dreaded complications 2. Peritonitis 3. Bronchitis and pneumonia 4. Meteorism or excessive distention of the bowels (tympanites) 5. Thrombosis and embolism 6. Early heart failure 7. “Typhoid spine” or neuritis 8. Septicemia 9. Reiter’s syndrome - joint pain, eye irritation and painful urination that can lead to chronic arthritis 4. Convalescent Stage gradual disappearance of signs and symptoms Diagnostic tests: ▪Clinical examination ▪Culture of Blood, bone marrow, urine , stool for S. typhi, rectal swab ▪Serological Tests : Typhidot - confirmatory ▪ELISA (Enzyme Linked Immunoassay) ▪Widal test Treatment Medication: Antibiotics Antibiotics, such as ampicillin, Chloramphenicol (Drug of choice for treatment of typhoid fever ), fluoroquinolone trimethoprim- sulfamethoxazole, Amoxicillin and ciprofloxacin etc. are used to treat typhoid fever. If the patient does not respond to chloramphenicol, 3rd and 4th generation drugs are administered. NURSING MANAGEMENT 1. Isolation by the medical aseptic technique 2. Maintain or restore fluid and electrolyte balance by giving nourishing fluids in small quantities at frequent intervals. 3. Monitor the patient’s vital signs. 4. Prevent further injury (such as falls) of patient with typhoid psychosis. 5. Maintain good personal hygiene and mouth care. 6. Cooling measures are necessary during the febrile state. 7. Watch out for signs of intestinal bleeding. PREVENTION and CONTROL 1. Sanitary and proper disposal of excreta 2. Proper supervision of food handlers 3. Enteric isolation 4. Provision of adequate amounts of safe drinking water supply 5. Reporting of cases to health authorities 6. Detection and monitoring of typhoid carriers 7. Education of the general public on the mode of transmission 8.Terminal and concurrent disinfection 9. Observe character of stool 10. Observe enteric precaution 11 Position to prevent aspiration 12.Monitor for presence of complications 13. Administer medication as prescribed 8. Immunization 9. Handwashing 10.Avoid mode of transmission 11. Decontamination of water sources, milk pasteurization  Leptospirosis/ Weil’s Disease/Canicola Fever/ Mud Fever ▪Leptospirosis/ Weil’s Disease/Canicola Fever/ Mud Fever - An infection in rodents and other wild and domesticated species. ▪Zoonotic infectious bacterial disease carried by animals, both domestic and wild. Infected urine contaminates water or food, which causes disease when ingested or inoculated through the skin https://homeopathyfortheworld.blogspot.com/2018/05/leptospirosis-causes-symptoms-diagnosis.htm l?spref=pi Risk Factors : https://www.slideshare.net/yuyuricci/leptospirosis-76942576 Causative agent:Leptospira interrogans Incubation period: 6 -15 days / 7-10 days Period of Communicability: -Leptospira is found in the urine between 10 to 20 days after disease onset and may be excreted in the urine for 1 month while in some other cases up to 11 months. Source of Infection 1. Infection comes from contaminated food and water and infected wildlife and domestic animals, especially rodents. 2. Rats (L. ictero haemorrhagiae) are the source of Weil’s disease frequently observed among mine, sewer and abattoir workers. 3. Rats (L. botaviae) are also the source of infection that attacks ricefield workers. 4. Dogs (L. canicola) can also be the source of infection among veterinarians, borders and owners of dogs. 5. Mice (L. grippotyphosa) may also be a source of infection that affects farmers and flax workers. Mode of Transmission 1. Direct inoculation into the broken skin , mucous membrane 2. Ingestion of urine/ fecally contaminated food and water 3. Leptospirosis is transmitted through ingestion or contact with the skin or mucous membranes of infected urine or corpses of either wild or domestic animals. 4. The disease can be transmitted through the mucous membranes of the eyes, nose, and mouth, and through breaks in the skin. 5. Leptospira enters the blood to cause damage, thereafter, in the kidneys, the livers, meninges and conjunctivae. 6. Leptospirosis can also be transmitted by the semen of infected animals. 7. Leptospirosis is common among water sport enthusiasts in certain areas as prolonged immersion in water is known to promote the entry of bacteria 8. Occupations at risk include veterinarians, slaughterhouse workers, farmers and sewer workers. 9. Humans-to-human transmission is rare. Signs and Symptoms Leptospirosis usually occurs in two phases: A. First phase: About 2 to 20 days after infection occurs, fever, headache, sore throat, severe muscle aches in the calves and back, and chills occur suddenly. The eyes usually become very red on the third or fourth day (Orange eyes, pathognomonic sign of Leptospirosis). Some people cough, occasionally bringing up blood, and have chest pain. Most people recover within about 1 week. B. Second (immune) phase: In some people, symptoms recur a few days later. They result from inflammation caused by the immune system as it eliminates the bacteria from the body. The fever returns, and the tissues covering the brain and spinal cord (meninges) often becomes inflamed (meningitis). https://www.slideshare.net/MohdSaifKhan/meningitis-epidemiology-diagnosis-and-management ▪ Weil syndrome/ Severe Leptospirosis ▪ This form can occur during the second phase. It causes jaundice (yellowish discoloration of the skin and whites of the eyes that is caused by liver damage), kidney failure, and a tendency to bleed. People may have nosebleeds or cough up blood, or bleeding may occur within tissues in the skin, lungs, and, less commonly, digestive tract. Anemia can develop. Several organs such as the heart, lungs, and kidneys may stop functioning. https://www.slideshare.net/sasiprasad/leptospira-9695414 Complications 1. Meningitis 2. Respiratory distress 3. Renal intestinal tubular necrosis that results in renal failure (Weil’s disease) 4. Cardiovascular problems. Diagnostic tests 1. Blood Culture 2. Leptospira Agglutination test 3. Leptospira Antigen -Antibody Test 4. BUN and Creatinine 5. Complete blood count (CBC) 6. Creatine kinase 7. Liver enzymes (SGPT/ Alanine Aminotransferase (AST), SGOT/ Aspartate Aminotransferase (AST) 8. Liver function test results are usually are slightly to moderately elevated Treatment Medical. Treatment of leptospirosis is geared toward: a. Suppressing the causative agent b. Fighting possible complications 1.) 5-to-7-day course of some antibiotics like : Ampicillin Azithromycin Ceftriaxone Doxycycline – Drug of Choice Penicillin 2.) IV fluid for hydration, administration of electrolytes ,blood as indicated 3.) Peritoneal Dialysis Nursing Management A. Health teaching 1. Provide education to clients telling them to avoid swimming or wading in potentially contaminated water or flood water. 2. Use of proper protection like boots and gloves when work requires exposure to contaminated water. 3. Drain potentially contaminated water when possible. 4. Control rats in the household by using rat traps or rat poison, maintaining cleanliness in the house. B. Management: 1. Isolate the patient and concurrent disinfection of soiled articles. 2. Stringent community-wide rat eradication program.Remove rubbish from work and domestic environment to reduce rodent population. 3. Report all cases of leptospirosis. 4. Investigation of contacts and source of infection 5. Chemoprophylaxis can be done in a group of high risk infected hosts Prevention and Control General preventive measures include: 1. Education for the public on modes of transmission, such as advice to avoid swimming or wading in potentially contaminated waters, and to use appropriate personal protection when work requires potential exposure 2. Information dissemination campaign must be conducted effectively. 3. Protecting workers in hazardous occupations with boots and gloves 4. Covering abrasions and sores on skin with waterproof dressings 5. Rodent control around human habitations 6. Prompt treatment and isolation of infected domestic animals. 7. Sanitation in homes, workplaces and farms is a must. 8. There is a need for proper drainage system and control of rodents (40- 60% infected). 9. Animals (cattle, dogs, cats and pigs) must be vaccinated. 10. Infected humans and pets should be treated. 11 Cases should be nursed with blood and body fluid precautions. Any articles soiled with urine should be disinfected. 12. The patient should be advised that they may continue to excrete leptospires in the urine for a month or more after the acute infection. Cholera It is an acute bacterial enteric disease of the GIT characterized by profuse diarrhea, vomiting, and massive loss of fluid and electrolytes, which could result in hypovolemic shock, acidosis and death. https://www.medindia.net/patients/waterborne/chol era.htm Risk Factors for Cholera https://www.slideshare.net/shaikhani/cholera-who-lancet-statements  Etiologic agent: Vibro cholerae/ Vibrio coma 1. The organism is a slightly curved rod (comma- shaped), Gram-negative and motile with a polar flagellum. 2. The organism survives well at ordinary temperature and multiplies well in temperatures ranging from 22- 40 degrees centigrade. 3. They survive longer in refrigerated food. 4. An enterotoxin, choleragen, is elaborated by the organism as it grows in the intestinal tract. https://www.news-medical.net/life-sciences/Quorum-Sensing-and-Vibrio-Cholerae.aspx ▪Pathognomonic sign: -Rice-watery stools ▪Incubation period: -The incubation period ranges from a few hours to 5 days, usually 1 to 3 days. ▪Period of communicability: -The organism are communicable during the stool- positive stage, usually a few days after recovery; however, occasionally the carrier may have the organism for several months. Mode of Transmission: 1. Fecal transmission passes via the oral route from contaminated water, milk and other foods. 2. The organisms are transmitted through the ingestion of food or water contaminated with the stool or vomitus of a patient. 3. Flies, soiled hands, and utensils also serve to transmit the infection. Clinical Manifestations: 1. There is an acute, profuse, watery diarrhea with no tenesmus or intestinal cramping. 2. Intially the stool is brown and contains fecal material, but soon becomes pale gray and "rice water-like" in appearance, with an inoffensive, slight fishy odor. 3. Vomiting often occurs after diarrhea has been established. 4. Diarrhea causes fluid loss amounting to 1 to 30 liters per day, owing to subsequent dehydration and electrolyte loss. 5. Tissue turgor is poor and eyes are sunken into the orbits. 6. The skin is cold; the fingers and toes are wrinkled, assuming the characteristics "washerwoman's hand." 7. Radial pulses become imperceptible and blood pressure unobtainable. 8. Cyanosis is present 9. The voice becomes hoarse and then is lost, such that the patient speaks in whisper (aphonia) 10. Breathing is rapid and deep. 11. Despite marked diminished peripheral circulation, consciousness is present. 12. The patient oliguria and sometimes even anuria 13. Temperature could be normal at the disease but becomes subnormal in later stages, especially if the patient is in shock. 14. When the patient is in deep shock, the passage of diarrhea stop. 15. Death may come as rapidly as four hours after onset, but usually on the first or the second day if not properly treated. Diagnostic exams 1. Rectal swab 2. Darkfield or phase microscopy 3. Stool exam 4. Blood and stool culture 5. Rapid detection in stool using PCR (Polymerase Chain Reaction) Modalities of treatment Treatment of cholera consists of correcting the basic abnormalities without delay- restoring the circulating blood volume and blood electrolytes to normal levels. 1. Intravenous treatment is achieved by rapid intravenous infusion of an alkaline saline solution containing sodium, potassium, chloride and bicarbonate ions in proportions comparable to that in water-stool. 2. Oral therapy rehydration can be completed by the oral route (ORESOL, HYDRITES) unless contraindicated or if the patient is not vomiting. 4. Antibiotics a. Tetracycline 500mg every 6 hours might be administered to adults; 125mg/kg body weight for children every 6 hours for 72 hours b. Furazolidone 100mg for adult and 125mg/kg for children might be given every 6 hours for 72 hours. c. Chloramphenicol may also be given 500mg for adult and 18mg/kg for children every 6 hours for 72 hours. d. Cotrimoxazole may also be administered 8mg/kg for 72 hours Nursing management 1. Medical aseptic protective care must be provided. Handwashing is imperative before any food item is handled. 2. Enteric isolation must be observed. 3. Vital signs must be recorded accurately. 4. Intake and output must be accurately measured. 5. A through and careful personal hygiene must be provided. 6. Excreta must be properly disposed of. 7. Concurrent disinfection must be applied. 8. Food must be properly prepared. 9. Environmental sanitation must be observed. 10. Weighing the patient provides additional data that there is no deficit in fluid input. 11. Appropriate diet is given according to the stage of recovery. Prevention and Control 1. Drink only safe and clean water. If unsure, boil drinking water (Upon reaching boiling point, extend boiling for two or more minutes), or 2. Do water chlorination. 3. Keep food away from insects and rats by covering it. 4. Wash and cook food properly. 5. Sanitary disposal of human waste. 6. Use toilet properly and clean toilet everyday. 7. Wash hands with soap after using toilet and before eating. 8. Keep surroundings clean to prevent flies and other insects and rodents from breeding. Amoebic Dysentery ▪Is a protozoal infection of human beings initially involves the colon, but may spread to soft tissues, most commonly the liver and lungs by contiguity or hematogenous or lymphatic dissemination Risk Factors https://www.slideshare.net/moliabdu/amoebiasis-52969330 Amoebiasis (amoebic dysentery) Etiologic Agent: Entamoeba histolytica ▪Prevalent in unsanitary areas ▪Common in warm climates ▪Acquired by swallowing - Cyst survives a few days outside of the body - Cyst passes to the large intestine and hatches into a trophozoite. It passé into the mesenteric veins, the portal vein, and finally to the liver, where it causes amoebic liver abscess Source ▪Human excreta Incubation period ▪The incubation period in severe infections is three days. In sub-acute and chronic from it last for several months. In average cases the incubation period varies from three to four weeks. Period of communicability ▪The microorganism is xcommunicable for the entire duration of the illness. Mode of Transmission 1. The disease can be passed from one person to another through fecal-oral transmission. 2. The disease can be transmitted through direct contact, through sexual contact by orogenital, oroanal, and proctogenital sexual activity. 3. Through indirect contact, the disease can infect humans by ingestion of food, especially uncooked leafy vegetables or foods contaminated with fecal material containing E.histolytica cysts. 4. Food or drinks may be contaminated by cysts through pollution of water supply, exposure to flies, use of night soil for fertilizing vegetables, and through unhygienic practices of food handlers. Clinical Manifestation 1. Acute amoebic dysentery a) Slight attack of diarrhea, altered with periods of constipations and often accompanied by tenesmus. b) Diarrhea, watery , and foul-smelling stools often containing blood-sneaked mucus. c) Colic and gaseous distension of the lower abdomen. d) Nausea, flatulence, abdominal distension, and tenderness in the right iliac regions over the colon. 2. Chronic amoebic dysentery a) Attack of dysentery that last for several days usually succeeded by constipation. b) Tenesmus accompanied by the desire to defecate. c) Anorexia, weight loss, and weakness d) The liver may be enlarged. e) Stools at first are semifluid, but soon become watery, bloody and mucoid. f) Vague abdominal distress, flatulence, constipation or irregularity of bowel movement. g) Mild toxemia, constant fatigue, and lassitude h.) The abdomen loses its elasticity when picked up between the fingers. i) On sigmoidoscopy, scattered ulceration, with yellowish and erythematous border is noted. j)The gangrenous type (fatal) is characterized by the appearance of large sloughs of intestinal tissues in the stools, accompanied by hemorrhage 3. Extra-intestinal forms a) Hepatic b) Pain in the upper right quadrant with tenderness of the liver c) Jaundice d) Intermittent fever e) Loss of weight or anorexia f) Abscess may break through the lungs; patients coughs” anchovy-sauce sputum. Clinical features of Amoebiasis 1. Onset is gradual 2. Diarrhea increases and stools becomes bloody and mucoid. 3. In treated cases: Fluid stools = severe bloody-mucoid stool Hemorrhage = intestinal perforation Peritonitis = DEATH Diagnostic exams 1. Stool exam (cysts; white and yellow pus with plenty of amoeba) 2. Blood exam (leukocytes) 3. Proctoscopy/sigmoidoscopy ▪Treatment 1. Metronidazole (flagyl) 800 ng TID x 5days. 2. Tetracycline 250 mg every 6 hours 3. Ampicillin, quinolone, sulfadiazine 4. Streptomycin SO4,chloramphenicol 5. Lost fluids and electrolytes should be replaced. Nursing management 1. Observe isolation and enteric precaution 2. Provide health education and instruct patient to: a) Boil water before drinking or use purified water b) Avoid washing food with water from open drum or pails c) Cover leftover food d) Wash hands after defecations and before eating and e) Avoid eating ground vegetables (lettuce , carrots and the like ) 3. Proper collection of stool specimen. ▪Never give paraffin or any oil preparation for at least 48 hours prior to the collection of specimen. ▪Instruct the patient to avoid mixing urine with stool ▪If whole stools cannot be sent to the laboratory, select as large portions containing blood and mucus as possible ▪Send the specimen immediately to the laboratory; stools that are not fresh ▪Label the specimen properly 4. Skin care ▪Cleanliness and freedom from wrinkles on the sheet will be helpful with all the usual precautionary measures against pressure sores 5. Mouth care 6. Provide optimum comfort ▪The patient should be kept warm. Dysenteric patients should never be allowed to feel cold, even for a movement 7. Diet ▪During the acute stages, fluids should be forced ▪In the beginning of an attack, cereals and strained meat broths without fat should be given ▪Chicken and fish may be added when convalescence is established ▪A bland diet without cellulos or bulk-producing foods should be maintained for a long time. Prevention and Control 1. Health education 2. Sanitary, disposal of feces 3. Protect chlorinate, and purify drinking water 4. Observe scrupulous cleanliness in food preparation and food handling 5. Detection and treatment of carriers 6. Fly control ( they can serve as vectors ) Bacillary dysentery ▪is an acute bacterial infection of the intestines characterized by diarrhea and fever and is the associated with the passing out of bloody-mucoid stools accompanied by tenesmus ▪Etiologic Agent ▪The causative agent is a bacterium of the Shigella group, a short, non-motile, Gram-negative organism. https://www.netterimages.com/bacillary-dysentery-unlabeled-internal- medicine-frank-h-netter-2161.html ▪There are four serologic groups: ▪ Shigella flexnari (group B) – common in the Philippines ▪Shigella Boydii – Common in Asia ▪Shigella sonnei ▪Shigella dysenteriae ✔Considered as the most infectious ✔Their habitat is exclusively the GIT of man ✔Like other Gram –negative bacilli, they develop resistance against antibiotics ✔They rarely invade the blood stream ▪Incubation Period ▪seven hours to seven days, with an average of three to five days. ▪Period of Communicability ▪The patient is capable of transmitting the microorganism during the acute infection until the feces are negative of the organism. Some patient remain carriers for a year or two. Mode of Transmission ▪The organism is transmitted through ingestion of contaminated food or water or milk. ▪It may be transmitted by flies or through other objects contaminated by feces of the patient. ▪Fecal-oral transmission is possible. Clinical Manifestation ▪Fever, especially in children ▪Tenesmus, nausea, vomiting, and headache ▪Colicky or cramping abdominal pain associated with anorexia and body weakness ▪Diarrhea with bloody mucoid stools that are watery at first ▪Rapid dehydration and loss of weight Complications 1. Rectal prolapse , particularly in undernourished children 2. Respiratory complications, such as cough and pneumonia 3. Non-Suppurative arthritis and peripheral neuropathy Diagnostic Procedure ▪Fecalysis or microscopic examination of stools. ▪Isolation of the causative organism from rectal swab or culture ▪Peripheral blood examination ▪Blood culture ▪Sheets of polymorphonuclear leukocytes seen in staining with methylene blue Treatment ▪Antibiotics are of question in the treatment of shigellosis; however, ampicillin. Tetracycline, and cotrimoxazole may be useful in severe cases. ▪IV might be infused with normal saline (with electrolytes) to prevent dehydration ▪Low-residue diet is recommended ▪Anti-diarrheal drugs are contraindicated because they delay fecal excretion that can lead to prolonged fever Nursing Management ▪Maintain fluid and electrolyte balance to prevent profound dehydration ▪Keep the patient warm and comfortable ▪Restrict food until nausea and vomiting subsides ▪Isolation can be carried out through medical aseptic technique ▪Personal hygiene must be maintained ▪Excreta must be properly disposed ▪Concurrent and terminal disinfection should be employed ▪Return to normal activities must be gradual because relapse may occur as a result Prevention and Control 1. Sanitary disposal of human feces 2. Sanitary supervision of processing, preparation, and serving of food, particularly those eaten raw. 3. Adequate provisions of safe washing facilities 4. Fly control and protection against fly contamination 5. Isolation of patient during acute stage 6. Protection and purification of public water supply 7. Persons known to be infected should be excluded from handling food for public consumption Hepatitis Hepatitis A HEPATITIS A (Infectious hepatitis/ Catarrhal jaundice) -Hepatitis A is a liver disease caused by the hepatitis A virus. This is an inflammation of the liver that is not really very severe and runs an acute course. -This generally starts within 2 to 6 weeks after contact with the virus, and lasts no longer than 2 months. INCUBATION PERIOD -The incubation period for hepatitis A is 2-7 weeks PERIOD OF COMMUNICABILITY - 1 week before appearance of symptoms until 1 week after appearance of symptoms MODE OF TRANSMISSION -The virus is transmitted through fecal-oral pathway: 1. Ingestion of contaminated drinking water or ice, uncooked fruits and vegetables, and fruits and vegetables grown in or washed with contaminated water; and 2. contamination of food/ drinks by infected food handlers. Signs and Symptoms of Hepatitis ( all types) A. Pre –Icteric Stage 1. Flu-like illness with chills and high fever 2. Diarrhea, fatique and abdominal pain 3. Loss of appetite 4.Nausea B. Icteric Stage 5. Jaundice and dark- colored urine 6. Acholic stool 7. Right Upper Quadrant pain COMPLICATIONS 1.Progressive encephalopathy characterized by drowsiness and cerebral edema 2.GIT bleeding to stupor and later coma. Bleeding is not responsive to parenteral vitamin K administration. 3.Clonus and hyperreflexia are later replaced by loss of deep tendon reflexes 4. Edema and ascitis 5. Aplastic anemia 6. In the late course of the disease, loss of corneal and papillary reflexes, elevated arterial blood, respiratory failure, and cerebrovascular collapse may be present. DIAGNOSTIC PROCEDURES 1.HAV and HBV- serological test 2. Liver function test- Ex: liver enzymes : SGOT-serum glutamic oxaloactic transaminase/ SGPT serum glutamine pyruvic transaminase/Alkaline phosphatase 3. Bile examination of stool and urine sample 4. IgM level NURSING MANAGEMENT 1. The patient must be isolated (enteric isolation). 2. Patient should be encouraged to rest during the acute or symptomatic phase. 3. The patient's nutritional status must be improved. 4.Appropriate measures to minimize spread of the disease must be taken. 5. Observe the patient for melena and check stools for the presennce of blood. 6. Provide optimum skin and oral care. 7. Increase the ability to carry out activities. a. Encourage the patient to limit activity when fatiqued. b.Assist the client in planning periods of rest and activity. c. Encourage gradual resumption of activities and mild exercise during recovery.  Treatment Modalities 1.There is no specific treatment, although bed rest is essential. 2.Diet must be high in carbohydrates, low in fat and low in protein. 3. Patient must be take vitamin supplements, especially the B complex group. 4.Intravenous(methisoprenol) may enhance the cell-mediated immunity of the T- lymphocytes. 5. Alkalies, belladonna,anti- emetics should be administered to control dyspepsia and malaise. PREVENTION OF CONTROL 1. Hands should be washed thoroughly after using the toilet. 2.Travelers should avoid water and ice if unsure of their purity. 3. Food handlers should be carefully screened. 4. Safe preparation and serving of food must be practiced. 5. The public should be educated in the mode of transmission of the disease.  HEPATITIS B (Serum Hepatitis) -is the inflammation of the liver caused by the hepatitis B virus. This considered more serious than hepatitis A due to possibility of severe complications such as massive damage or hepatocarcinoma of the liver. -It was once thought to be transmitted only through direct exchange of contaminated blood. Hepa B is now known to be transmitted also by contact with human secretions and stools. Recipients of plasma-derived products and hemodialysis clients are particularly at risk. Etiologic Agent The disease is caused by the Hepatitis B virus. 1. This virus has very limited tissue tropism. 2. HBV infects the liver and possibly the pancreas. 3.HBsAg appears in the blood 30 to 60 days after exposure and persists for variable periods of time. INCUBATION PERIOD The incubation is 2 to 5 months with a mean equal to 90 days. PERIOD OF COMMUNICABILITY The patient is capable of transmitting the virus during the latter part of the incubation period and during the acute phase. The virus may persist in the blood for many years.  Mode of Transmission 1. Hepatitis B can be directly transmitted by person- to-person contact via infected body fluids. 2. It can be transmitted through contaminated needles and syringes. 3. Transmission can occur through infected blood or body fluids introduced at birth. 4. It can also be transmitted through sexual contact. CLINICAL MANIFESTATION 1. PRODOMAL PERIOD a. Fever, malaise and anorexia b. Nausea, vomiting, abdominal discomfort, fever and chills c. Jaundice, dark urine and pale stools d. Recovery is indicated by a decline of fever and improved appetite. Fulminant Hepatitis may be fatal and manifested by severe symptoms like ascites and bleeding. DIAGNOSTIC PROCEDURES 1. Compliment fixation test 2. Radio-immunoassay-hemagglutinin test 3.Liver function test ( Liver enzymes, albumin, Alk. Phosphatase) 4.Bile examination in blood and urine 5. Complete Blood count 6. HBsAg( Hepatitis B Surface Antigen) Treatment for Chronic Hep B 1.) anti viral drugs- fights the virus , slows ability of virus to damage the liver 2) Interferon – enhance immune system to fight the viral infection of the liver 3) Liver transplant – replaces the damage liver Prevention and Control 1. Blood donors must be screened to exclude carriers 2. Caution must be observed in giving care to patients with HBV 3. Hands and other skin areas must be washed immediately and thoroughly after contact with body fluids 4. Avoid injury with sharp objects or instruments 5. Use disposable needles and syringes only once and discard properly 6. Avoid sharing toothbrushes, razors and other instruments that may be contaminated with blood 7. Practice safe sex 8. Get adequate rest, sleep and exercise and eat nutritious foods 9. Hepa B vaccine is recommended for pre- exposure 10. Hepatitis immune globulin should be administered within 72 hours to those exposed directly to hepatitis B virus by either ingestion, prick or inoculation Hepatitis C / Post –Transfusion Hepatitis ▪is blood borne infectious disease caused by the hepatitis C virus originally known as “non-A, non-B hepatitis” ▪-the infection is often asymptomatic, but once established can cause scarring of the liver (fibrosis) and eventually, cirrhosis (advance scarring) ▪The hepa C virus is associated with a high rate of chronic liver diseases ▪Clients with chronic hepatitis C are considered infectious ▪No vaccine is available for hepatitis C Incubation period: 2 weeks to 6 months Period of Communicability: From one or more weeks before the onset of symptoms most persons are probably infectious indefinitely. Mode of Transmission: a. unsafe injection practices b. inadequate sterilization of medical equipment in some health-care settings; and c. unscreened blood and blood products Signs/Symptoms 1. Belly pain 2. Clay-colored poop 3. Dark urine 4. Fatigue 5. Fever 6. Jaundice (yellow tint to your skin or eyes) 7. Joint pain 8. Poor appetite 9. Nausea 10. Vomiting Diagnostic Tests 1.Anti- Hepa C antibodies 2.PCR ( Plolymerase Chain reaction) 3.Liver function tests – detects extent of damage caused by Hepa C virus Treatment and Management 1.Interferon – amped the immune system 2.Ribavirin- anti –viral drug Prevention 1.Never share needles 2.Avoid direct exposure to blood and blood products 3.Avoid sharing personal care items 4.Practice safe sex 5.Choose tattoo and piercing parlors carefully  Hepatitis D ▪Also known as delta virus, is a small circular RNA virus Incubation Period: 2-8 weeks Period of Communicability: People infected with HDV are thought to be most infectious before the onset of acute illness. Mode of Transmission: Exposure to infected blood and serous body fluids; and contaminated needles, syringes, blood and plasma product transfusions. Sexual transmission may also occur but is less common than with HBV. ▪A patient can have both hepa D virus infection and Hepa B virus, this is called co-infection Symptoms of Hepatitis D Hepatitis D doesn’t always cause symptoms. When symptoms do occur, they often include: 1. yellowing of the skin and eyes, which is called jaundice 2. joint pain 3. abdominal pain 4. vomiting 5. loss of appetite 6. dark urine 7. fatigue Diagnosis ▪High titers of Immunoglobulin G (IgG) and Immunoglobulin M (IgM) anti-HDV ▪Confirmed by detection of HDV RNA in serum. Treatment 1. Interferon 2. Liver transplantation may be considered for cases of fulminant hepatitis and end-stage liver disease Prevention and control of Hepa D Virus infection 1. Requires prevention of HBV transmission through hepatitis B immunization, 2. blood safety, 3. injection safety, and 4. harm reduction services. Note: Hepatitis B immunization does not provide protection against HDV for those already HBV infected.  Hepatitis E ▪Is inconsistently shed in stools, therefore, detection is difficult ▪Is a common cause of hepatitis that is transmitted via the intestinal tract. Spread is most often by drinking contaminated water ▪It never becomes a chronic illness, but on rare occasions the acute illness damages and destroys many liver cells that liver can no longer function. This is called fulminant liver failure. ▪ Hepa E virus is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4–6 weeks. ▪Incubation Period: 2 to 10 weeks ▪Period of Communicability: when virus is already cleared from the blood and stool Mode of Transmission Transmitted enterically (fecal-oral and waterborne routes), like Hepatitis A. Symptoms ▪Mild fever ▪Feeling very tired ▪Less hunger ▪Feeling sick to your stomach ▪Throwing up ▪Belly pain ▪Dark pee ▪Light-colored poop ▪Skin rash or itching ▪Joint pain \ ▪jaundice Diagnosis Treatment ▪In most cases, hepatitis E goes away on its own in about 4-6 weeks. These steps can help ease your symptoms: ▪Rest ▪Eat healthy foods ▪Drink lots of water ▪Avoid alcohol Prevention 1. No vaccine can prevent the hepatitis E virus. It’s most common in less- developed countries in Asia, the Middle East, Africa, and Central America. You can lower your chances of getting the virus if you: 2. Don’t drink water or use ice that you don’t know is clean. 3. Don’t eat undercooked pork, deer meat, or raw shellfish. 4. Wash your hands with soap and water after you use the bathroom, change a diaper, and before you prepare or eat food.