Hepatitis A, B, C: Clarissa Isidra D.Guiang BSN

Hepatitis A,B,C
CLARISSA ISIDRA D.GUIANG

BSN
Hepatitis defined as inflammation of the

liver and is classified as either viral or non
viral.
Hepatitis A(Infectious
hepatitis/Catarrhal jaundice)
*A
liver disease caused by the hepatitis A . An

inflammation of the liver that is not really very
severe and runs an acute courses. This generally
starts within 2-6 weeks after contact with the virus
and lasts no longer than 2 months. It is known as
infectious hepatitis because its spreads relatively
easy individual who have close contact with the
infected.
Incubation Period- Ranges from 15-60 days

or 3-5 weeks with a mean incubation period
of 30 days.
Period of Communicability
*Infected Patient is capable of transmitting the
organism from a week before until a week after the
appearance.
Mode of Transmission
The virus is transmitted through the fecal
oral pathway:
1. Ingestion of contaminated drinking water or ice,

uncooked fruits and vegetables and fruits and
vegetables grown in or washed contaminated.
2. Contaminated of foods/drinks by infected food
handlers.
Pathology/ Pathogenesis
1. Following ingestion , HAV enters the bloodstream
through the epithelium of the oropharynx or intestines.
2. The blood carries the virus to its target the liver, where it
lives and multiples within the hepatocytes and Kupffer
cells.
3. Virions are secreted into the bile and released in stools.
HAV is excreted in large quantities approximately 11
days prior to the appearance of symptoms or anti HAV
IgM antibodies in the blood.
Clinical Manifestations
Flu-like illness with chills and high fever.

Diarrhea, fatigue and abdominal pain
Loss of appetite
Jaundice and dark colored urine
Infection in young children is often mild and
asymptomatic.
Hep A does not have a chronic stage and does not cause
permanent liver damage.
Disease can prevented by hep. A vaccine.
Complications
Progressive encephalophaty characterized by drowsiness
and cerebral palsy.
GIT bleeding progressing to stupor and later coma. Bleeding
is not responsive to parenteral vitamin K administration.
Clonus and hyper reflexia are later replaced by loss of deep
tendon reflexes.
Edema and ascitis
Aplastic anemia
Loss of corneal and papillary reflexes
Elevated arterial blood
Respiratory failure
Cerebrovascular collapse may be present
Diagnostic Procedure
HAV and HBV-complement fixation rate

Liver function test- determine the presence and extent
of liver damage and check the progress of the liver.
Bile examination of stool and urine samples
SGOT- Serum Glutamic Oxaloacetic transaminase
SGPT- Serum glutamic pyruvic transaminase
ALT- Serum alanine transminase
IgM level
Treatment Modalities
No specific treatment although bed rest is essential
Diet must be high in carbohydrates , low fat and low
protein
Patient must take vitamin supplements especially vit. B
complex.
IV theraphy is occasionally necessary.
Isoprinosine( methisoprenol) may enchance the cell
mediated immunity of T-lymphocytes.
Alkalies, Belldonna and anti emetics should be
administered to control dyspepsia and malaise.
Nursing Management
Patient must be isolated(enteric isolation)
Patient should be encourage to rest during acute and
symptomatic phase.
Patient nutritional status must be improved
Appropriate measure to minimize spread of disease
Observe patient MELENA and check stool for the presence of
blood
Provide optimum skin and oral care
Increased the ability to carry out activities
A. Encourage the pt. to limit activity when fatigued
B. Assist the client in planning periods of rest and activity
C. Encourage gradual resumption of activities and mild
exercise during recovery.
Prevention and Control
Hands should be washed after using toilet

Avoid water and ice if unsure of their purity especially
travelers
Food handlers should be carefully screened
Safe preparation and serving of food must be practiced
Public should educated on the Mode OF transmission of
diease.
Hepatitis B ( Serum Hepatitis)
Inflammation of the liver considered to be more serious

than hep. A due to the possibility of severe
complications such as massive damage and
hepatocarcinoma of the liver. To be transmitted only
through direct exchange of contaminated blood..
Transmitted also contact with human secretions and
stools. Recipients of plasma derived products and
hemodialysis clients are particularly at risk.
Etiologic Agent
virus has limited tissue tropism

HBV infects the liver and possibly the pancreas
HBsAg appears in the blood 30-60 days after exposure
and persists for variables period of time.
Incubation Period
Is 50-189 days or 2-5 months with mean equal to 90

days.
PERIOD OF COMMUNICABILITY
Pt. is capable of transmitting the virus during the latter
part of the incubation and during the acute phase. May
persists in the blood for many years.
Mode of Transmission
Hep. B can be directly transmitted by person-person

contact via infected body fluids
Transmitted through contaminated needles and syringes
Transmitted through sexual contact
Trough infected blood or body fluids introduced at birth
HBV transmission does not occur

via:
The fecal oral route
Foodborne or waterborne transmission
Arthropod(mosquito) transmission
Pathogenesis
Primarily interferes with the functions of the liver by
replicating in liver cells known as hepatocytes.
The host immune response causes both hepatocellular
damage and viral clearance.
Virus replicates and large amounts of HBsAg are

released into the blood in addition to virions.
Virus replication may be soon as 3 days from acquisition
may not be observed until 45 days or much longer.
During the acute phase infection the liver parenchyma
shows degenerative changes consisting of cellular
swelling and necrosis, especially in hepatocytes.
Clinical Manifestation
1. PRODOMAL PERIOD
-the time during which a disease process has begun but
is not yet clinically manifest.
a. Fever , malaise, anorexia
b. nausea , vomiting abdominal discomfort, fever , chills
c. jaundice, dark urine and pale stools
d. recovery is indicated by a decline of fever and
improved appetite.
2. FULMINANT HEPATITIS- may be fatal and manifested
by severe symptoms like ascites and bleeding.
Diagnostic Procedure
Compliment fixation test

Radio immunoassay hemaglutinin test
Liver function test
Bile examination in blood & urine
Blood count
Serum transaminase HBsAg
SGOT,SGPT,ALT
Prevention
Blood donors must be screened to exclude carriers.

Caution must be observed giving care to pt. infected
HBV.
Avoid injury with sharps obj. and instruments
Hands and skin must be washed
Disposable needles and syringes only once and discard
properly
Avoid sharing of toothbrushes , razors and other
instrument contaminated with blood
Practice safe sex
Get adequate rest, sleep and exercise and eat nutritious

foods
Hep. B vaccine is recommeded for pre exposure.
HEPATITIS IMMUNE GLOBULIN(HBIg) ahould
administered within 72 hrs to those exposed directly by
ingestion, prick or inoculation.
Hepatitis C
an infectious disease affecting primarily the liver, caused
by the hepatitis C virus (HCV). The infection is often
asymptomatic, but chronic infection can lead to scarring of
the liver and ultimately to cirrhosis, which is generally
apparent after many years. In some cases, those with
cirrhosis will go on to develop liver failure, liver cancer, or
life-threatening esophageal and gastric varices. spread
primarily by blood-to-blood contact associated with
intravenous drug use, poorly sterilized medical equipment,
and transfusions. An estimated 150200 million people
worldwide are infected with hepatitis C.The existence of
hepatitis C (originally identifiable only as a type of non-A
non-B hepatitis) was suggested in the 1970s and proven in
1989. Hepatitis C infects only humans and chimpanzees.
Signs and symptoms
Acute infection
Symptoms are generally mild and vague, including a
decreased appetite, fatigue, nausea, muscle or joint
pains, and weight loss and rarely does acute liver failure
result. Most cases of acute infection are not associated
with jaundice.The infection resolves spontaneously in
1050% of cases, which occurs more frequently in
individuals who are young and female.
Incubation
15-160 days
Adults 40-59 yrs.old
Chronic infection
defined as the presence of detectable viral replication for

at least six months. Most experience minimal or no
symptoms during the initial few decades of the infection.
Chronic hepatitis C can be associated with fatigue and
mild cognitive problems.Chronic infection after several
years may cause cirrhosis or liver cancer.The liver
enzymes are normal in 753%.Late relapse after
apparent cure have been reported, but these can be
difficult to distinguish from reinfection.
Treatment/medications
HCV induces chronic infection in 5080% of infected
persons. Approximately 4080% of these clear with
treatment. In rare cases, infection can clear without
treatment.Those with chronic hepatitis C are advised to
avoid alcohol and medications toxic to the liver, and to
be vaccinated for hepatitis A and hepatitis B. Ultrasound
surveillance for hepatocellular carcinoma is
recommended in those with accompanying cirrhosis.
is recommended for those with proven HCV infection

and signs of liver inflammation. treatments consist of a
combination of pegy lated interferon alpha and the
antiviral drug ribavirin for a period of 24 or 48 weeks,
depending on HCV genotype. Combining either
boceprevir or telaprevir with ribavirin and peginterferon
alfa improves antiviral response for hepatitis C
genotype. Sofosbuvir with ribavirin and interferon
appears to be around 90% effective in those with
genotype 1, 4, 5, or 6 disease.Sofosbuvir with just
ribavirin appears to be 70 to 95% effective in type 2 and
3 disease but has a higher rate of adverse effects
Mode of transmission
Hepatitis C is mainly spread via contaminated blood. It
can be passed by the following.
Through contact with an infected person's blood.
Transmission from mother to child (less than 5 per cent
risk).
The virus can be contracted by accidental pricking with a
contaminated needle this mainly concerns healthcare
workers.
Sexual transmission among heterosexuals is rare, but
there have been recent concerns regarding possible
sexual transmission among gay men with HIV.
Symptoms
incubation period, from the time of exposure to the virus until
the onset of the disease, is one to six months. Most patients
have no symptoms. Early symptoms include poor appetite,
nausea, aching muscles and joints.
Later symptoms include yellowing of skin, mucous membranes,
and whites of the eyes (jaundice, icterus); light-coloured stools;
and dark urine. Once the late symptoms have developed, in
most cases the patient quickly begins to get better. The disease
typically lasts two to eight weeks.
Chronic or ongoing infection occurs in 60 to 80 per cent of those
infected. These patients generally have no symptoms but some
may complain of fatigue.
Over decades chronic infection can cause scarring of the liver
which can lead to cirrhosis with risk of liver failure and liver
cancer.
PREVENTION
Avoid sharing needles and syringes.

Avoid sharing razors and toothbrushes with an infected
person.
Practise safer sex with condoms.
Unfortunately, there's no vaccine to prevent hepatitis C
virus infection.
Thank
you

Hepatitis A, B, C: Clarissa Isidra D.Guiang BSN

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Hepatitis A, B, C: Clarissa Isidra D.Guiang BSN

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Hepatitis A,B,C

CLARISSA ISIDRA D.GUIANG

Hepatitis defined as inflammation of the

liver disease caused by the hepatitis A . An

Incubation Period- Ranges from 15-60 days

1. Ingestion of contaminated drinking water or ice,

Flu-like illness with chills and high fever.

HAV and HBV-complement fixation rate

Prevention and Control

Hands should be washed after using toilet

Hepatitis B ( Serum Hepatitis)

Inflammation of the liver considered to be more serious

virus has limited tissue tropism

Is 50-189 days or 2-5 months with mean equal to 90

Hep. B can be directly transmitted by person-person

HBV transmission does not occur

Virus replicates and large amounts of HBsAg are

Compliment fixation test

Blood donors must be screened to exclude carriers.

Get adequate rest, sleep and exercise and eat nutritious

Signs and symptoms

defined as the presence of detectable viral replication for

is recommended for those with proven HCV infection

Avoid sharing needles and syringes.

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