Denisse Viña T.

Pascual & Bernadette de Dios

Caregiving Batch 4 – Group I
Hepatitis
 Inflammation of the liver
 Can be caused by:
 Virus
 Autoimmunity
 Drugs/ Medications
 Alcohol
 Non-alcoholic cause - fats
Liver
 largest internal organ that supports

almost every other organ in your body

 reddish-brown appearance and feels

rubbery to the touch

 largest gland in the human body

 It is bigger in human males (around

10.5cm) than that in females.(about 7 cm)

 The liver weight is also different in

different genders. Normal liver weighs

about 1.2 to 1.5 kg in females and males,

respectively.
Liver - Functions
 Purify the body from different harmful substances, for example, toxins

 Secretes chemicals in the form of bile or liver juice. Bile contains salts that

neutralize the acidic food coming from stomach. Meanwhile, the bile juice also

helps in the digestion of fats.

 Processing Nutrients and Storage of Vitamins, Iron and Minerals

 Blood Reservoir

 Restoration of Glucose Level

 Synthesis of Blood Clotting Factors & Other Plasma Proteins

 Detoxification of Poisons and Drugs, Lipid Metabolism and Alcohol Metabolism

 Destruction of Old RBCs

Viral hepatitis
• Viruses attack the hepatocytes
ATTACK • It will present abnormal CHON: MHC class I molecule

• Immune cells will try to see what’s wrong with the liver.
RECOGNIZE • CD8+ T-CELL – recognize that the cells were infected.

• Cytotoxic Killing
APOPTOSIS • COUNCILMAN BODY – hepatocytes undergoing apoptosis.

INFLAMED
• HEPATITIS

DAMAGE
• LIVER DAMAGE
General Signs and Symptoms
 Fever
 Malaise
 Nausea
 hepatoMEGALY
 RUQ Pain
 Jaundice
 Weight Loss
 Dark Urine (due to ↑Bilirubin & ↑ Urobilinogen in urine)
 ↑↑Alanine aminotransferase/ ALT
 ↑ Aspartate aminotransferase/AST
 ↑Atypical Lymphocytes

*Note: it can also be asymptomatic.

Hepatitis A
 formerly known as infectious hepatitis or epidemic jaundice
 acute infectious disease caused by Hepatitis A virus (HAV).
 Non-specific signs and symptoms
 Fever
 Chills
 Headache
 Fatigue
 Generalized weakness and pains
 Anorexia
 Nausea and vomiting
 Dark urine
 Jaundice

**The disease is benign with complete recovery in several weeks.

 Hepatitis A - Agent Factors
 AGENT
 Hepatitis A virus (HAV)
 is an enterovirus of the Picornaviridae
family.
 It multiplies only in hepatocytes.
 RESISTANCE
 The virus is fairly resistant to heat and
chemicals.
 Withstands heating to 600 C for 1 hr.
 Not affected by chlorine in doses usually
employed for chlorination.
 Formalin is stated to be an effective
disinfectant.
 The virus is inactivated by ultraviolet rays
and by boiling for 5 minutes or
autoclaving.
Hepatitis A - Agent Factors
 RESERVOIR OF INFECTION
 The human cases are the only reservoir of infection.
 PERIOD OF INFECTIVITY
 The risk of transmitting HAV is greatest from 2 weeks
before to 1 week after the onset of jaundice.
 INFECTIVE MATERIAL
 Mainly man’s feces.
 VIRUS EXCRETION
 HAV is excreted in the feces for about 2 weeks before
onset of jaundice and for up to 2 weeks thereafter.
Hepatitis A - Host Factors
 AGE
 Infection with HAV is more frequent
among children than in adults. However,
people from all ages may be infected if
susceptible.
 SEX
 Both sexes are equally susceptible.
 IMMUNITY
 Immunity after attack probably lasts for
life.
Hepatitis A – Mode of Transmission
 Incubation period 10-50 days (usually 25 to 30 days)

 FECAL-ORAL ROUTE
 Major route of transmission.
 by contaminated water, food or milk.
 PARENTERAL ROUTE (Rarely)
 By blood and blood products or by skin penetration through
contaminated needles.
 SEXUAL TRANSMISSION
 May occur mainly among homosexual men because of oral-
anal contact.
Hepatitis A – Diagnostic Tests
 Demonstration of Virus in feces, blood, bile by
Immunoelectron microscopy
 Virus Isolation
 Detection of Antibody by ELISA
 Anti-HAV IgM and IgG
 Blood tests
 Alanine aminotransferase (ALT
 Bilirubin
 Protein
 Molecular Diagnosis
 RT PCR (Reverse Transcription Polymerase Chain Reaction)
of feces
Hepatitis A – Treatment and Prevention
 Preventions
 hygienic measures and sanitation
 passive immunization
 Human IgG given before exposure to virus or early
during the incubation period, will prevent or
attenuate a clinical illness.
 active immunization
 Several inactivated or live attenuated vaccines against
hepatitis A have been developed.
 Treatment
 nospecific, dietary food and long rest
Hepatitis B
 formerly known as serum hepatitis
 is an acute systemic infection with major
pathology in the liver, caused by hepatitis B
virus.
 acute illness causes liver inflammation,
vomiting, jaundice, and, rarely, death.
 Chronic hepatitis B may eventually cause
cirrhosis and liver cancer.
 endemic throughout the world, especially in
tropical & developing countries.
Hepatitis B – Agent Factors
 AGENT
 Hepatitis B Virus
(HBV)
 complex, 42 nm
double-shelled DNA
virus originally known
as ―Dane Particle
 replicates in liver cell
Hepatitis B – Agent Factor
 RESERVOIR OF INFECTION
 Men is the only reservoir of infection which can
be spread either from carriers or from cases.
 Infective material
 Contaminated blood is the main source
 Virus has been found in body secretion such as
saliva, vaginal secretion & semen in infected
material.
 Resistance
 Readily destroyed by sodium hypochlorite as is
by heat sterilization in an autoclave for 30-60
min.
Hepatitis B – Host Factors
 -Acute hepatitis B: Chronic hepatitis B
 90% resolve by •2-10% progress to chronic
themselves state
 <1% develop fulminant •occur in approximately:
hepatic failure •Perinatal: 95%
 occurs in approximately:
•Childhood: 80%
•After 5 yr. of age: 5-10%
 perinatal: 1%

 Childhood: 10% (1-

5yo)
 Late infection: 30%
(>5yo)
Hepatitis B – Host Factors
 High Risk Group:
 People from endemic regions
 Babies of mothers with chronic HBV
 Intravenous drug abusers
 People with multiple sex partners
 Hemophiliacs and other patients requiring
blood and blood product treatments
 Health care personnel who have contact with
blood
 Patients who are immunocompromised.
Hepatitis B – Host Factors
 Humoral and cellular response
 HBV has 3 distinct antigen:
 HBsAg – surface Ag
 HBcAg – core Ag

 HBeAg - envelope Ag

 They stimulate production of

corresponding antibody.
Hepatitis B – Mode of Transmission
 Incubation Period: 45-180 days (usually 60-90
days)
 Parenteral
 IV drug abusers, health workers are at increased risk.
 Sexual
 sex workers and homosexuals are particular at risk.
 Perinatal (Vertical)
 mother (HBeAg+) →infant
 Mothers who are HBeAg positive are much more likely
to transmit to their offspring than those who are not.
 Perinatal transmission is the main means of
transmission in high prevalence populations.
Hepatitis B – Diagnostic Tests
 Serology
 Liver Chemistry tests AST, ALT, ALP, and total
Bilirubin
 Histology
 Immunoperoxidase staining
 HBV Viral DNA
 Most accurate marker of viral DNA and detected
by PCR
 Liver Biopsy
 to determine grade (Inflammation) and stage
(Fibrosis) in chronic Hepatitis
Hepatitis B – Prevention
 Vaccination
 highly effective recombinant vaccines
 Hepatitis B Immunoglobulin (HBIG)
 exposed within 48 hours of the incident/
neonates whose mothers are HBsAg and HBeAg
positive.
 Other measures
 screening of blood donors, blood and body fluid
precautions.
Hepatitis B - Treatment
 Interferon Alfa (Intron A)
 Response rate is 30 to 40%.
 Lamivudine (Epivir HBV)
 relapse ,drug resistance
 Adefovir dipivoxil
 Hepsera
Hepatitis C
 an infectious disease affecting primarily the
liver, caused by the hepatitis C virus (HCV).
 The infection is often asymptomatic
 Chronic infection → scarring of the liver
(cirrhosis)
 Can lead to chronic hepatitis
Hepatitis C – Agent Factor
 HCV
 50-60 nm virus with a linear,
single stranded RNA genome,
enclosed with in a core and
surrounded by an envelope,
carrying glycoprotein spikes.
 member of the Hepacivirus genus in the
family Flaviviridae.
 half life of the virus particles in
the serum is around 3 hours and
may be as short as 45 minutes.
 In addition to replicating in the
liver the virus can multiply in
lymphocytes.
Hepatitis C – Mode of Transmission
 Incubation Period: 40-120 days
 Intravenous Drug Use
 Healthcare Exposure
 Blood Transfusion, transfusion of Blood products,
Organ Transplant without HCV screening carry
significant risk of infection.
 Hemodialysis
 Accidental injuries with needles/sharps
 Sexual/household exposure to anti-HCV-positive contact
 Multiple sex partners
 Vertical Transmission
 Vertical transmission of hepatitis C from an infected mother to her
child
Hepatitis C – Diagnostic Tests
 HCV antibody
 ELISA
 Not useful in the acute phase as it takes at least 4 weeks after
infection before antibody appears.
 HCV-RNA
 PCR
 branched DNA
 used to diagnose HCV infection in the acute phase.
 main use is in monitoring the response to antiviral therapy.
 HCV-antigen
 EIA for HCV antigen
 It is used in the same capacity as HCV-RNA tests but is much
easier to carry out.
Hepatitis C - Prevention
 General Prophylaxis:
 blood, tissue, organ screening, is possible.
 No specific active or passive immunizing agent is
available.

Hepatitis C - Treatment
 Interferon - may be considered for patients with chronic
active hepatitis.
 Ribavirin - there is less experience with ribavirin than
interferon. However, recent studies suggest that a
combination of interferon and ribavirin is more effective
than interferon alone.
Hepatitis C - Treatment
 Interferon
 may be considered for patients with chronic
active hepatitis.
 Ribavirin
 there is less experience with ribavirin than
interferon. However, recent studies suggest
that a combination of interferon and
ribavirin is more effective than interferon
alone.
Hepatitis D
 classified as Hepatitis delta virus
 is a disease caused by a small circular
enveloped RNA virus.
 HDV is considered to be a subviral satellite
because it can propagate only in the
presence of the hepatitis B virus (HBV).
Hepatitis C – Agent Factor
 VIRION: spherical, 36-
38 nm particle with an
outer coat composed of
the HBsAg surrounding
ssRNA genome.

 Satellite virus :
replicates only in the
presence of HBV
Hepatitis D – Mode of Transmission
 Incubation Period:
 2-12 weeks
 The primary MOT are believed to be similar
to those of HBV, though HDV does not
appear to be sexually transmitted disease.
Hepatitis D – Clinical Features
 Infection is dependent on HBV replication
 HBV provides an HBsAg envelop for HDV
 Two types of infection:
 Coinfection, delta and HBV are
transmitted together at the same time
 Superinfection, delta infection occurs in a
person already infected with HBV.
Hepatitis D – Diagnostic Test
 Immunofluorescence
 For delta antigen expression
 ELISA
 For anti-delta antibodies found in serum
 IgM antibody appears 2-3 weeks after
infection and is soon replaced by the IgG
antibody in acute delta infection.
Hepatitis D - Prevention
 HBV-HDV Coinfection Pre or post
exposure prophylaxis to prevent HBV
infection
 Screening of blood donor for HBsAg
 HBV-HDV Superinfection Education to
reduce risk behaviors among persons
with chronic HBV infection.
Hepatitis E
 Caused by hepatitis E virus (HEV
 often causes an acute and self-limiting infection (in
that it usually goes away by itself and the patient
recovers) with low mortality rates.
 It bears a high risk of developing chronic hepatitis in
immunocompromised patients with substantial
mortality rates.
 occasionally develops into an acute, severe liver
disease, and is fatal in about 2% of all cases.
 In pregnant women the disease is more often severe
and is associated with a clinical syndrome called
fulminant hepatic failure.
Hepatitis E – Agent Factor
 HEV is spherical non-
enveloped virus, 29-nm to 32
nm in diameter, with a
ssRNA genome.
 The surface of the virion
shows indentation and
spikes. The Virus is very
labile.
 It has been classified in the
genus Herpes virus under
the family Caliciviridae.
Hepatitis E – Host Factor
 Animal Reservoir: Pigs

Mode of Transmission
 Incubation Period: 2-9 weeks
 spread mainly by the fecal-oral route due to fecal
contamination of water supplies or food
 person-to-person transmission is uncommon
Hepatitis E – Diagnostic Test
 ELISA
 IgG and IgM antibodies
 use recombinant and synthetic peptide antigens

Prevention
 Sanitation: Avoid drinking water of unknown
purity, uncooked shellfish and meat, and
uncooked fruit/vegetables not peeled or prepared
by traveler.
INTERVENTIONS
 Encourage the pt to eat small frequent
meals, ↓fat&CHON,↑Carbs&fluid
 Provide supportive care.
 Encourage the pt to have a proper hygiene
practice
 Brief the family about the pt’s dse
 Use gloves when making contact with the
pt’s blood and other body fluids
INTERVENTIONS
 Proper handwashing
 Always treat the linen and utensils as infectious
 Give the pt his own bedpan/urinal and cutlery
 Isolation is continued for the 1st 2weeks of the
illness and 1 week after the onset of jaundice.
 Don’t let the pt drink alcohol or take over-the-
counter drugs w/o consulting the doctor.
COMPLICATIONS
 Cirrhosis (scarring→liver malfunction)
 Hepatocellular carcinoma
 Liver failure
 Emotional pain