Background Hepatitis is a general term that refers to inflammation of the liver. Infectious etiologies include: viral, fungal, and parasitic organisms. Medications, toxins and autoimmune disorders may cause non-infectious hepatitis. There are several types of hepatitis which include: A, B, C, B with D, E, F, and G

A healthy human liver (top) contrasted with a liver from an individual that died from hepatitis C (bottom). Note the extensive damage and scarring from chronic liver disease.

You are at risk for hepatitis if…… Inject illegal drugs Have received a tattoo or body piercing in unsafe conditions. Have hemophilia Travel to areas where hepatitis is common Have unprotected sex with multiple partners or with someone who has HBV Received a blood transfusion or solid organ transplant before July 1992 Received a blood product for clotting problems produced before 1987 Have a job that involves contact with human blood

Hepatitis A oMost commonly, the virus spreads from person to person via the fecal-oral route. Contaminated water and food have also resulted in epidemics of HAV. oThe virus may also spread via infected serum. oThe incubation period of HAV is 2-7 weeks, with an average of 28 days oMost common signs and symptoms include fatigue, nausea, vomiting, fever, hepatomegaly, jaundice, dark urine, anorexia, and rash. oOther complications can include acute liver failure, cholestatic hepatitis, and relapsing hepatitis

Hepatitis B HBV transmits both parenterally and sexually, most often by mucous membrane exposure or percutaneous exposure to infectious body fluids. Another significant mode of transmission is perinatal transmission. The incubation period for HBV varies from days, with the average approximately 75 days. Signs and symptoms include right upper quadrant pain, fever, arthritis, arthralgias, or an urticarial rash. As the disease progresses, the liver becomes tender, and jaundice develops. Patients may note that their urine darkens and that their stools lighten in color. Other symptoms include nausea, ascitis, vomiting, and pruritus.

Hepatitis C HCV can be transmitted parenterally, perinatally, and sexually. Needlestick injuries among health care workers place them at significant risk of infection. Incubation period for HCV runs days, with symptoms developing anywhere from 5-12 weeks after exposure. Symptoms may appear similar to those of HBV infection. In up to 80% of cases, however, patients are asymptomatic. Approximately 50-85% of patients with HCV become chronically infected with HCV; of those, 29-76% later develop chronic active hepatitis or cirrhosis.

Some famous people living with hepatitis C……. Pamela Anderson Steven Tyler of Aerosmith

Hepatitis D & E Hepatitis D HDV, an incomplete virus, requires the presence of HBV to replicate. The incubation period of HDV is approximately 35 days. Patients co-infected with HBV and HDV tend to have a more severe disease course than those infected with HBV alone. Hepatitis E Hepatitis E virus is the primary cause of enterically transmitted non-A, non-B hepatitis. HEV is transmitted primarily by the fecal-oral route, with fecally contaminated water providing the most common means of transmission. The incubation period is 2-9 weeks with an average of 45 days.

Diagnosing Urine panel (for presence of bilirubin) Liver enzyme panel Determining the presence of specific antibodies for hepatitis A, B, & C in serum. The third-generation tests can detect such antibodies within 4-10 weeks of infection. Liver biopsy may be recommended for the initial assessment of disease severity in patients with chronic hepatitis B or chronic hepatitis C. There are no specific imaging studies required to make the diagnosis of hepatitis.

Basic Treatment Patients should be admitted if there is; any signs or symptoms of severe complications, altered mental status, or changes in sleep- wake cycle. A PT prolonged greater than 3 seconds, bilirubin greater than 10 mg/dL, and hypoglycemia. those who are immunocompromised; and those who are older than 50 years. Bed rest is commonly prescribed Alcohol is not allowed for at least 1 year Most patients will tolerate small frequent meals of a low fat high carb diet If the patient is dehydrated, IV fluids with additives of vitamins C, B, and K are given. o Supportive therapy for existing signs and symptoms and preventing the transmission of the disease are important in the treatment

Sample Meds Drug therapy for both Chronic Hepatitis B and C are focused on decreasing the viral load, decreasing the rate of disease progression, and decreasing the rate of drug resistant B and C. Medications for HBV Lamivudine (Epivir 3TC), & - interferon, and adefovir dipivoxil (Hepsera) Medications for HCV Interferon alfa-2b(Intron A), ribavirin (Rebetol), PEG – interferon alfa-2a (Pegasys)

Liver Transplant Recipients can increase both quantity and quality of life. Liver disease related to chronic viral hepatitis is the leading indication for liver transplantation. Half of all transplant recipients are HCV positive. Most transplanted livers will eventually become infected with HCV % of patients will develop cirrhosis by the 5 th year of the transplant. Postoperative care is focused on monitoring for signs of infection, rejection and hemorrhage, assessment of electrolyte levels, pulmonary complications, neurological status, and I&O’s Emotional support and teaching the patient and the family is also very essential

Patient teaching Instruct patients not to share any articles with potential for contamination with blood, semen, or saliva, including needles, toothbrushes, or razors. Inform food handlers suspected of having HAV not to return to work until their primary care physician can confirm that they are no longer shedding virus. Instruct patients to refrain from using any hepatotoxins, including ethanol and acetaminophen. Advise patients in general to exercise meticulous personal hygiene including strict hand washing. A patient does not have to be at risk, to be told about the vaccine available for Hepatitis B.

Prognosis Varies with causative virus Hepatitis A virus - usually is mild and self-limited. Infection confers lifelong immunity against HAV. Hepatitis B virus - Fulminate hepatic failure develops in 0.5-1% of patients infected with HBV; their case-fatality rate is 80%. Hepatitis C virus - responsible for 10,000 deaths each year in the United States. Hepatitis D virus - Chronic co-infection with HBV and HDV often leads to rapidly progressive sub acute or chronic hepatitis with as many as 70-80% of these patients eventually developing cirrhosis. Hepatitis E virus - usually is mild and self-limited. Case- fatality rate reaches 15-20% in pregnant women. Does not result in chronic disease.

Liver Abscesses Another presentation by: Stephanie Licano

What is it? How do I know if the patient has it? If the body was not successful on destroying bacteria, the body builds toxins that attack liver cells. Then the necrotic tissue that was produced makes a protective wall. The result is a pyogenic cavity full of dead and living leukocytes, bacteria, and liquefied liver cells. Classic (but vague) Signs and Symptoms include: Fever with chills and abdominal tenderness in the right upper quadrant. Plus the health care provider may find.. Heptomegaly, jaundice and anemia

Another way to diagnose Radiograph CT scan Ultrasound Liver scan Lab exam of antigen-antibody reaction of amebae in the serum

Treatment? What does the patient need to know? They can usually be managed by medical therapy, such as a full course antibiotic therapy that is specific to the organism identified. Percutaneous draining may be for patients who are not responding to medical treatment or are at high risk for rupture If the abscess has ruptured then open surgical drainage may also be used The patient should be aware of an increase of signs of symptoms and to tell the physician immediately.

Prognosis The prognosis is much improved from the old mortality rate of 100% This is because advanced diagnostic tests, including the CT scan and liver scans.