Definition of hepatitis – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Definition of hepatitis
hepati-tis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. hepati-tis viruses are the most common cause of hepati-tis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepati-tis.
There are 5 main hepati-tis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
hepati-tis A and E are typically caused by ingestion of contaminated food or water. hepati-tis B. C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepati-tis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
(Ref by-http://www.who.int)
According to World Health Organization (WHO):
hepati-tis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer.
Or,
Inflammation of the liver which result in damage to hepatocytes with a subsequent cell death.
(Ref by-K. Park/23/210)
Classification of hepati-tis:
A. According to duration:
a) Acute hepati-tis
b) Chronic hepati-tis
B. According to etiology:
a) Viral infection:
- hepati-tis A virus (HAB)
- hepati-tis B virus (HBV)
- hepati-tis C virus (HCV)
- hepati-tis D virus (HDV)
- hepati-tis E virus (HEV)
- Herpes simplex virus (HDV)
- Cytomegalo Virus (CMV)
- Epstein Barr virus (EBV)
- Yellow fever virus
b) Auto immune disorder: toxins alcohol drug
c) Miscellaneous: Wilson’s disease
(Ref by-K. Park/23/210)
Preventive and Controlling Measures of HAV and HEV:
1. Proper sanitation:
- Improving water supply
- Proper excreta disposal
- Maintenance of hygiene (personal and environmental)
- Sanitary improvements of food stores and kitchen
2. Health education about:
- Use of safe drinking water and sanitary latrine
- Proper disposal of excreta
- Food handlers should be educated in matters of food hygiene
- Adequate breast feeding and improved weaning practices
3. Fly control: Controlling breeding of flies in association with faeces and dirty water.
4. Timely control of epidemics: By strengthening of epidemiological surveillance systems.
5. Vaccination: Vaccine for hepati-tis A is available but not for hepati-tis E
6. Screening of blood donors for hepati-tis A
Preventive and Controlling Measures of hepati-tis B, C, D:
1. Avoid risk factors
- Shared needles
- Homosexuality and illiegimate heterosexuality
- Prostitute
- Professional blood donors
- Carriers: They should not share razors and tooth brushes, Use barrier methods of contraception and should not donate blood
2. Screening of blood donors and encouraging voluntary blood donation
3. Standard safety precautions in hospitals and other health care settings: To avid accidental needle puncture and contact with infected body fluids.
4. Active immunization: HBV vaccine
5. Passive immunization: By hepati-tis immunoglobulin for immediate protection to acutely exposed HBs Ag positive blood, preferably within 6 hours
- Surgeons, nurses and laboratory workers
- Newborn infants of carrier mothers
- Sexual contacts of acute hepati-tis B patients
6. Passive active immunization
hepati-tis A and E
Definition of hepati-tis A:
hepati-tis A is an acute infectious disease caused by hepati-tis HAV.
A) Agent’s factors:
- Agent: Causative agent is hepati-tis A virus
- Resistance: The virus is resistance to heat and chemical
- Reservoir of infection: Human cases only
- Period of infectivity: 2 weeks before and 1 week after the onset of jaundice.
- Infective materials: Human faeces, Blood, Serum and body fluids.
B) Host factors:
- Age: All age groups can be affected. More frequent among children than adult.
- Sex: Both sexes can be equally affected
C) Mode of transmission:
- Faeco oral route
- Parenteral route (through blood or contaminated by needle)
- Sexual route
D) Incubation period: 2-6 weeks
E) Sign and symptoms: Symptoms may be mild or even no symptoms, but the person faeces are still infectious to others. The usual features are:
- A short, mild, flu-like illness: Fever, chills, malaise and fatigue
- Nausea, vomiting and diarrhea
- Loss of appetite
- Weight loss
- Dark urine and jaundice
- Itchy skin
- Abdominal pain
F) Investigation:
- Anti HAV
- Serum bilirubin
- SGPT and SGOT
G) Treatment: There is no specific treatment for HAV. The disease is self limiting and returns to normal within a couple of months. Only severely affected patients need hospitalization. General plan of treatment are-
1. Bed rest
2. Diet
- Protein restricted and no spicy foods
- Light diet supplemented by fruits, plenty of fluids, ORS, dab water and glucose drinks.
3. If severe vomiting: IV fluid and anti-emetic
4. Drugs: Sedatives, hypnotics, and diuretics, are usually avoided. It diuretics are to be used potassium sparing diuretics should be used
5. Clinical and biochemical follow up
(Ref by-Davidson/224)
short note on – hepati-tis E
Definition: Hepatitis E is the viral hepatitis caused by hepatitis E virus
Epidemiology: Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries like Bangladesh, especially if the disease is more severe in pregnant women. Incidence and risk factors: Symptomatic HEV infections is most common in young adults
Incubation period: 3-8 weeks
Mode of transmission: Faeco oral and water borne
Signs and symptoms: May be asymptomatic or mild illness without jaundice that goes undiagnosed, particularly in children, typical sign and symptoms are –
- Jaundice
- Loss of appetite
- An enlarged, tender liver
- Abdominal pain and tenderness
- Nausea and vomiting
- Fever
Investigation:
- Anti HAV
- Serum bilirubin
- SGPT and SGOT
Treatment: There is no specific treatment for HAV. The disease is self limiting and returns to normal within a couple of months. Only severely affected patients need hospitalization. General plan of treatment are-
1. Bed rest
2. Diet
- Protein restricted and no spicy foods
- Light diet supplemented by fruits, plenty of fluids, ORS, dab water and glucose drinks.
3. If severe vomiting: IV fluid and anti-emetic
4. Drugs: Sedatives, hypnotics, and diuretics, are usually avoided. It diuretics are to be used potassium sparing diuretics should be used
5. Clinical and biochemical follow up
Preventive and Controlling Measures of HAV and HEV:
A. Proper sanitation:
- Improving water supply
- Proper excreta disposal
- Maintenance of hygiene (personal and environmental)
- Sanitary improvements of food stores and kitchen
B. Health education about:
- Use of safe drinking water and sanitary latrine
- Proper disposal of excreta
- Food handlers should be educated in matters of food hygiene
- Adequate breast feeding and improved weaning practices
C. Fly control: Controlling breeding of flies in association with faeces and dirty water.
D. Timely control of epidemics: By strengthening of epidemiological surveillance systems.
E. Vaccination: Vaccine for hepatitis A is available but not for hepatitis E
F. Screening of blood donors for hepatitis A
Hepatitis-B
Mode of Transmission of Hepatitis B Virus:
A. Parenteral transmission:
a) Infected unscreened blood and blood products.
b) Tattoos/acupuncture needles
c) A mode of spread most common among parenteral drug miss-users who share needles or other injecting paraphernalia.
d) Contaminated syringes and surgical instruments
B. Sexual route:
a) Close personal contact seems necessary for transmission
b) Sexual intercourse especially in male homo sexual and heterosexuals is an important route of transmission of infection.
C. Perinatal or Vertical transmission:
a) Before birth has not been documented
b) During birth has not been documented.
c) During birth, most of the transmission occur, when placenta is separated, leakage of blood infect the baby.
d) Infection occur After birth, during HBV contaminated with breast milk
D. Close living quarters or playground play as a toddler.
Management a Patient Affected by Hepatitis B Virus Infection
Clinical features:
A. Symptoms:
- Headache
- Myalgia
- Arthralgia
- Yellow coloration of eye and skin
- Dark urine and pale stool
- Nausea and anorexia
- Vomiting
- Diarrhea
- Abdominal discomfort
- Fever
B. Signs:
- Jaundice
- Enlarged tender liver
- Occasionally, mild splenomegaly and cervical lymphadenopathy are seen.
C. Investigation:
- Blood examination: TC, DC, Hb%, ESR
- Liver function test: Serum bilirubin, Serum AST and ALT-raised, PT, Serum alkaline phosphatase level
Viral markers:
– Ig M-anti HAV (hepatitis A virus)
– HBs Ag (Hepatitis B surface antigen)
– Ig M-Anti HBc (Hepatitis B core antigen)
D. Management:
a) Acute hepatitis B: There is no specific treatment only severely affected patients required hospitalization so that developing fulminate hepatic failure can be detected early.
- Bed rest (3 to 5 weeks)
- Diet: Normal diet with slight fat restriction)
- Nutritious diet containing 2000-3000 K Cal/d, good protein.
- If not tolerated light diet supplemented by fruit drink and glucose
- If severe vomiting give IV fluid and glucose
- Drug (Sedative, Hypnotic): Should be avoided especially in severe hepatitis.
- Clinical biochemical and imaging follow up.
- Treatment of complication
b) Chronic hepatitis B: Treatments are still limited, with no drug able to eradicate hepatitis B infection completely. Supportive treatment plus
- Drugs
✔ Interferon-alpha.
✔ lamivudine, 100mg/day orally
✔ Adefovir.
✔ Entecavir (more effective than lamivudin)
✔ Telbivudin.
✔ Tenofovir, 300 mg/day.
- Liver transplantation with prophylactic lamivudin and hepatitis B immunoglobulin’s
Complication of Hepatitis B Virus Infection:
- Full recovery in 90-95% of adults/resolution (fate)
- Acute hepatic failure.
- Relapsing hepatitis: Biochemical, Clinical
- Cholestatic hepatitis.
- Post hepatitis syndrome
- Hyperbilirubinamia.
- Aplastic anaemia
- connective tissue disease
- Renal failure
- Henoch schonlein purpura
- Papular acrodermatitis
- Chronic hepatitis
- Cirrhosis (hepatitis B, C)
- Hepato cellular carcinoma.
Preventive and Controlling Measures of Hepatitis B:
A. Avoid risk factors
- Shared needles
- Homosexuality and illegitimate heterosexuality
- Prostitute
- Professional blood donors
- Carriers: They should not share razors and tooth brushes, Use barrier methods of contraception and should not donate blood
B. Screening of blood donors and encouraging voluntary blood donation
C. Standard safety precautions in hospitals and other health care settings: To avid accidental needle puncture and contact with infected body fluids.
D. Active immunization: HBV vaccine
E. Passive immunization: By hepatitis immunoglobulin for immediate protection to acutely exposed HBs Ag positive blood, preferably within 6 hours
- Surgeons, nurses and laboratory workers
- Newborn infants of carrier mothers
- Sexual contacts of acute hepatitis B patients
F. Passive active immunization
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