Hepatitis B

serum hepatitis, post-transfusion hepatitis

Double shelled DNA hepadnavirus Spread by sex, blood, and body fluids Severe disease Prolonged illness Chronic problems in ~ 10%

Hepatitis B: Clinical Aspects

Incubation period: 45-180 days, average 60-90 days Onset insidious (subtle and treacherous) Symptoms more severe

Malaise, arthralgias, rash, nausea & vomiting

Often hospitalized One in 200 die from acute disease Chronic liver disease kills ten times as many

VIRAL HEPATITIS TYPES & PATTERNS

Hepatitis -A Hepatitis -B Hepatitis -C Hepatitis -D Hepatitis -E

Causative organism Types of Virus Incubation Period

Hepatitis A Virus Nonenveloped RNA Virus 15-45 days

Hepatitis -B Hepatitis -C Virus Virus Enveloped DNA Virus Single stranded RNA Virus

Hepatitis -D Virus Deprive RNA Virus

Hepatitis -E Virus Single stranded RNA Virus

30-180 days

15-160 days 30-180 days 14- 60 days

Transmission

Faeco-oral route,rarely blood borne

Parental, bloodproducts, Perinatal, Sexual etc.

Parental, bloodproducts, Perinatal, Sexual etc.

Parental, bloodproducts, Perinatal, Sexual etc.

Faeco-oral route

SEROLOGICAL MARKERS Acute infection

Hepatitis-A

Hepatitis-B

Hepatitis-C

Hepatitis-D

Hepatitis -E

IgM anti HAV

HbsAg,IgM,anti HBC HBeAgHBV DNA HbsAg,IgG,anti HBC Anti Hbs ,IgG,anti HBC Anti Hbs Asymptmatic Acute /chronic subclinical/rapidl y prograssive Interferon+/Lamivudine HBIG vaccine,aviod blood contaminatn,safe sex

HCV- RNA, Anti HCV HCV- RNA, Anti HCV Anti HCV-

IgM antiHDV,HDV Ag,HDV RNA IgG anti HDV

IgM Anti HEV/IgG Anti HEV Rarely

Chronic infection

IgG anti HAV rarely IgG anti HAV rarely IgG anti HAV Asymptmatic Fatal acute liver failure

Past infection

IgG anti HDV

-NA-

Previous immunization Spectrum of disease

-NAAsymptmatic Acute /chronic subclinical/rapidl y prograssive Interferon+/Rebiverine None.aviod blood contaminatn,safe sex

-NACoinfection/superinfec tion to Hepatitis-B

-NAAsymptmatic Fatal acute liver failure

Therapy Preventive measures

Non specific IgG Vaccine Improve hygeine

Non specific HBV Vaccine.aviod blood contaminatn,safe sex

Non specific Improve hygeine

Hepatitis B: Transmission

Virus present in blood, semen, saliva Percutaneous

Contaminated needles (tattoos, piercing, drugs, etc) Blood transfusion Perinatal

Permucosal

Sexual contact Continuous close contact

Concentration of Hepatitis B Virus in Various Body Fluids

High Blood Serum wound exudates

Moderate semen Vaginal fluid Saliva

Low urine feces sweat tears breast milk

Signs and symptoms

Yellowish eyes and skin called jaundice Swollen stomach or ankle Easy bruising Tiredness Upset stomach Fever Loss appetite Diarrhea Light colored stool Dark yellow urine

Hepatitis B Diagnosis/Serology
IgM anti-HBc (core antibody)

Appears early Persists for 6 months

HBsAg (surface antigen)

Detectable 30-60 days after exposure May indicate chronic carrier status Develops after resolved infection Indicates long term immunity

HBsAb (antibody to surface antigen)

Anti-HBc/HBcAb (antibody to core antigen)

Develops in all HBV infections

HBeAg (E antigen)

Indicates HBV replication Correlates with high infectivity Present in acute or chronic infection

Anti-HBe (antibody to E antigen)

Develops in most HBV infections Correlates with lower infectivity

Chronic Carrier State

Risk of chronic 90% of infants infection is lower 30% of 5 year olds after acute illness 6% of adults Prolonged infection can occur without signs or symptoms of acute or chronic illness

Hepatitis B is an STD

Many prostitutes in the Philippines, Thailand, and developing countries are hepatitis B carriers Sexual activity is #1 risk factor in U.S.

Hepatitis B Prevention

Education

Needles, sex, universal precautions

Pre-exposure, active immunity Post-exposure Passive immunity

Vaccine

HBIG

Medication

Interferon - for HBeAg +ve carriers with chronic active hepatitis. Response rate is 30 to 40%. alpha-interferon 2b (original) alpha-interferon 2a (newer, claims to be more efficacious and efficient) Lamivudine - a nucleoside analogue reverse transcriptase inhibitor. Well tolerated, most patients will respond favorably. However, tendency to relapse on cessation of treatment. Another problem is the rapid emergence of drug resistance.

Adefovir less likely to develop resistance than Lamivudine and may be used to treat Lamivudine resistance HBV. However more expensive and toxic Entecavir most powerful antiviral known, similar to Adefovir Successful response to treatment will result in the disappearance of HBsAg, HBV-DNA, and seroconversion to HBeAg

Surgery

Liver transplantation

Nursing dx
Fatigue R/T Decreased metabolic energy production Desire outcome: Report improved sense of energy Perform ADLs and participate in desire activity at level of ability. Intervention: Promote bedrest/chair during toxic state.

Provide quiet environment limit visitor as needed. Recommend change position frequently. Encourage use of stress management techniques. (e.g progressive relaxation, radio tv, reading

Fluid volume, risk for deficiency risk factor excess losses through vomiting and diarrhea 3rd space shift altered clotting factor Desire outcome: maintain adequate hydration, AEB stable vital signs, good skin turgor, capillary refill, and strong peripheral pulses. Intervention: Monitor I and O compare with periodic weight note enteric losses e.g vomiting and diarrhea. Asess vital sign and peripheral pulses, capillaryrefill

Skin turgor, and mucous membrane. Check for ascites edema formation measure abdominal girth as indicated. Observe for signs of bleeding e.g hematuria melena,

Self esteem, situational low R/T annoying debilitating symptoms, confinement isolation, length of illness recovery period. Desire outcome: verbalization of change in lifestyle, fear of rejection, reaction of others negative feelings about the body, feeling of helplessness. Intervention: Contract with patient regarding time for listening encourage discussion of feeling and concern.

Asess effect of illness in economic factors of patient and S.O offer diversional activities based on energy level