HEPATITIS

COURSE OBJECTIVES:

On completion of this class the student will have a better understanding of hepatitis, it's causes, it's treatments and the many dangers involved with it. Nursing will understand their importance of the prevention of this disease and their role in the care of the patient with hepatitis.

LEARNING OBJECTIVES:

  1. Student will be able to describe the physiological process of the liver and its function, R/t to the patient.
  2. Student will be able to verbalize hepatitis and its effects on the patient and S/S to look for.
  3. Student will have verbal knowledge of the different types of hepatitis and nursing role for each type.
  4. Student will have verbalize standard precautions, and will demonstrate proper care with all body fluids of the hepatitis patient, they also will verbalize the mode of transmission and their role in prevention.
  5. Student will have verbalize their understanding of the newest treatments for hepatitis and be able to educate their patients.

INTRODUCTION

The increasing incidence of hepatitis is a growing public concern. We started out with A, B, C and now we are up to A, B, C, D, and E. The number of people infected is growing dramatically. The scare use to be the deadly effects of Aids, but now with the increasing number of people infected with hepatitis is scaring the entire medical community.

ANATOMY AND PHYSIOLOGY OF THE LIVER:

The liver is the largest gland of the body and one of the most complex organs, it is the second largest organ in the body; the only organ larger is the skin.

The liver can be considered the chemical factory of the body. The liver’s job is to manufacture, accumulate, alter and excrete a large number of substances involved in metabolism. The liver receives nutrient-rich blood straight from the gastrointestinal tract. It then stores or transforms these nutrients into chemicals that are used throughout the body. The liver regulates glucose, proteins and it secretes bile. Bile plays a major role in digestion and absorption of fats. The liver functions as an organ of excretion. It removes waste products from the blood and secretes them back into the bile. The liver also breaks down the drugs and or medications that we ingest. The liver is the means of ridding the body of its toxic levels of drugs and alcohol.

The liver helps with blood clotting. The liver helps in the production and maintenance of prothrombin and fibergin. These are two factors that aid in blood clotting, without it the patient could bleed to death.

The liver is divided into four lobes. Each lobe is covered with a thin layer of connective tissue that extends into the lobes breaking them down into smaller parts called lobules. The liver weighs about 3 pounds.

You might feel the lower portion of the liver while doing your nursing assessment. You might hear a solid sound when tapping on the site of the liver, and can assess enlargement in this manner.

Unlike other organs such as the kidneys, the liver does not come in pairs and we are given only one. We must use our livers throughout our lifetime. One of the wonderful parts of the liver, are its cells. Liver cells can regenerate themselves unless the liver has been so badly damaged with diseases like hepatitis.

Hepatitis: The definition of hepatitis is; an inflammatory condition of the liver.

Hepatitis is a disease of the liver that is caused by one of the smallest microorganisms known to infect man. There are several types of hepatitis; a different hepatitis virus causes each. These viruses all have one thing in common, once they have entered the body they begin their life and reproduction in the living cell of its host. They multiply, attack and take over.

A VIRUS:

A virus is much simpler and smaller organism than the human cell. It is, in fact made up from a compact string of genes that are coated in proteins. (genes carry the code that lets the cell know what its function is.) Viruses carry only the tools they need to take over a cell. Among these basic tools for survival are blueprints. The blueprints allow the virus to make more copies of itself once it has invaded the healthy cell. The protein becomes a capsule for the virus protecting it from all.

Unlike other human cells that contain complex make-ups, such as digestion, energy production, etc., a virus exists only to reproduce itself.

The hepatitis virus mainly enters into the liver cell. The hepatitis cell latches onto the protein membrane and eases its way into the liver cell. Once inside the cell this virus gene is free to take over the normal function of the liver cell. This causes the liver cell to become weak and then it dies. Before it dies the virus cell has used the liver cell to reproduce itself thousands of times. These new and multi virus cells now live and begin to take over all of the healthy liver cells. The whole process can take place in a matter of hours. This process must occur many times before a person begins to show signs of liver damage.

Hepatitis, Acute or Chronic

An acute illness is one that develops quickly, has severe symptoms and last for six months or less.

A chronic illness is one that last longer than six months, the symptoms in a chronic illness can dissipate, or even vanish for period of time, then they reoccur.

4 TYPES OF HEPATITIS:

HEPATITIS A

A form of infectious hepatitis caused by the hepatitis A virus (HAVE). Hepatitis A is characterized by a slow onset of signs and symptoms, (S/S). The signs and symptoms are similar for all of the hepatitis; anorexia, malaise, headaches, pain over liver site, fever, most often is jaundice, itching and clay-colored stool, dark urine, nausea and vomiting, diarrhea and photophobia. Symptoms may be worse if the liver has already been damaged from chemical exposure (alcohol and drugs). Incubation period I for hepatitis A is 2-6 weeks and is most contagious during the first few weeks and one to two weeks after the signs and symptoms occur. Many times a person can carry the virus and never even know they have been exposed, but they can still be carriers and spread it through their feces and poor hygiene. Hepatitis A is acute hepatitis and does not become a chronic illness. The virus most often occurs in young adults and is usually followed by a full recovery. The mode of transmission for hepatitis A is fecal-oral. Food, water, or drinking and eating vessels that or contaminated with feces (stool). Causes include poor sanitation, crowded living conditions, poor nutrition and poor hygiene. The test would be one from a stool sample or blood test. There is a prophylactic one may acquire; immune gobulin is effective in households that have been exposed to the hepatitis virus. There is now an immunization's for hepatitis A available. Nursing care of this patient. Standard precautions are extremely important, hand washing, hand washing, hand washing. This patient might be on infectious isolation instead of just standard. Careful handling of anything that comes in contact with feces; bedpan, commode, briefs, rectal thermometers. Proper handling and disposal of waste is very important. Encouraging good nutrition and lots of fluids will assist their recovery. Patients will most likely be on I & O. Medicated baths will assist with their itching. The patient will need lots of rest and possible medications for nausea and itching. Avoid bright lights in the room. Education on the possible means of exposure and preventive measures for the future exposures needs to be given to the patient and family. 5

HEPATITIS B

The hepatitis B virus causes Hepatitis B. this virus has a ball-shaped capsule containing the viruses genetic material, which invades the liver. Hepatitis B is a very serious form of hepatitis and it effects more than one million Americans, with more than 14,000 more being infected each year. The hepatitis B virus causes the liver to become enlarged, irritated, and scarred. Hepatitis B has the ability to hide inside the body, some people do not even know they have been infected with the virus, until they are tested for some other reason.

Mode of transportation for hepatitis B is BLOOD TO BLOOD...

Blood may be present in many forms and be hidden in many places. All body fluids have a potential to be contaminated with blood. You do not have to see the blood for it to be there. It can happen with sex, IV drug use, sorting drugs and sharing the snorting tool, needle sticks, using someone's lipstick, toothbrush, ANYTHING THAT HAS EVEN A FEW BLOOD CELLS CAN GIVE YOU HEPATITIS B. The only way to test for hepatitis B is through a blood test. Hepatitis B can live up to 30 days outside the body. This virus is very strong and can live in your soap dish or under your patient's fingernails for a very long time. The incubation period for hepatitis B is six weeks to six months. It is contagious as long as it has a serum marker in the blood. The person can be a carrier for life with the potential to infect other people especially when it is in its acute stage. The patient can have flare ups throughout their life time making their hepatitis acute again.

Signs and symptoms depend on the health of the patient and the health of their liver at the time of exposure. The symptoms may be mild as if the person had the flu or they may become severe. They may include; nausea, vomiting, diarrhea, more common is jaundice, itching, clay colored stool and dark urine. Some of these symptoms occur because the liver can not break down bilrubin as it should so the skin and eyes will take up the yellow color of that bilirubin; this also causes the itching and dark urine. 6 The person may be very tired for weeks or even months. The site over the right abdomen, may become very sore, this is where the liver lies. The patient might complain of heaviness or a dragging sensation in their right abdominal area this can be from the enlargement of the liver. If the patient is experiencing a lot of these symptoms and feels very uncomfortable, this would more than likely is an acute stage. A chronic case of hepatitis may have little or no signs for periods of time. When the patient is run down and does not take care of them selves. When the patient returns to the source of the toxin that caused the liver to have the damage; drugs (legal or not) and alcohol. It is then that the hepatitis may revert back to an acute state. This causes a big problem for many people with hepatitis B. The patient feels better, their symptoms are few, so they return back to their drinking which in turn leads them to a sure death. The nursing treatment for this patient would be the same as for all hepatitis patients with emphasis on the fatal outcome of continuing to ingest chemical substances. Recovery programs need to be addressed by the medical professionals. There is a vaccine for Hepatitis B. The vaccine comes in a series of three. You need to get your first IM injection and then one month later you will receive the second, then six months from the first IM injection you need to get the third and final IM injection. It is extremely important that you receive all three of the IM vaccine series, and to do so in the time frame stated. If you do not follow the above schedule for the hepatitis B immunizations they will not be effective. To insure the effectiveness of the series, you SHOULD have a titer drawn six weeks after the completion of the series, and no later. If you are tested at a later date and the titer comes back negative, this does not mean you are not covered with the appropriate antigens. There is no understanding at this time on how long the vaccine is affective. The medical profession feels so strongly in favor of this immunization that it is started with newborn babies.

There is also an Immune Gobulin for Hepatitis B, if you have not received the hepatitis B series and are exposed to the virus you can get a one-time IM injection (immune gobulin). This will not stop the virus but it will lessen any and all of its potential symptoms. 7

HEPATITIS C

Hepatitis C is caused by the hepatitis C virus, which is also a ball-shaped capsule containing the viral gene that invades the liver cell.

Hepatitis C is a very serious form of hepatitis; it is the most common chronic hepatitis. Hepatitis C has effected 4 million people and continues to infect more than 30,000 each year. Hepatitis C is the cause of at least 10,00 deaths in the USA each year. Fifty percent of all liver transplants are from hepatitis C. We are spending over 4 billion dollars a year on this deadly virus and we are seeing increasing numbers of Hepatocellular cancer (liver), possibly in relationship to this virus.

Hepatitis C virus is similar to hepatitis B virus, you might be exposed to the virus and not even know you have it. Symptoms depend on the person's health status and the health of their liver. Signs and symptoms are the same as for the above hepatitis. One of the most common symptoms that occur in hepatitis C is fatigue. When a person is experiencing fatigue the last thing they feel like doing is exercise, but that it the best way to decrease their symptoms. Secondary infections may become a problem; these may need to be treated with antibiotics, good nutrition and increased fluids.

It is when chronic hepatitis C goes untreated that it causes scarring to the liver (cirrhosis) and an increased chance of liver cancer, and liver failure ending in death.

As with hepatitis B, when the hepatitis C virus enters your liver, it begins to invade the cells and grow. As it does this, the number of cells that are scarred and damaged increases. The person may not even feel any symptoms until so much damage has occurred that their liver is unable to function any longer. This can take 10 to 40 years. This depends on the individual, genetics, and how well you take care of your liver. Alcohol is a huge factor...

Incubation period is two to six weeks. It is contagious from the time the symptoms begin. A person can be a carrier for life. BLOOD also transfers hepatitis C. It can only be diagnosed with a blood sample.

Blood can be passed in many ways, as I said with hepatitis B. Nosebleeds, menstrual blood, shared earrings, chewing gum (abc gum). Just as with hepatitis B, hepatitis C is strong and lives outside the body for up to 30 days. . There have been cases of splashed blood on to a small open cut and the person was infected with the virus.

*There is no immunization or immune gobulin for hepatitis C. Once you get it, it is yours for life. You need to protect yourself! Treat everyone as if they are infected. Standard precautions, you need to use gloves, hand washing, and proper disposal of all waste. Once a person is infected with the hepatitis C virus, there is a treatment that can calm it down.

The antibodies that your body produces to fight against hepatitis B are much better than the ones that fight against hepatitis C. As a result your body needs a lot more help fighting off hepatitis C then it does any other kinds of hepatitis. The treatment to calm hepatitis C's destruction has been interferon injections. The patient is taught to inject themselves subcutaneously each day, for up to one year. Interferon causes flu like symptoms; this stops a lot of patients from using this treatment.

When a person has chronic hepatitis C with severe compensation to their liver, and they have not been treated with interferon in the past, there is now a new treatment regimen they can try. It is a combination called Rebetron.. This is an oral capsule of Rebetrol and an injection of interferon. This treatment can last six months to a year. Longer periods of treatment can give better results. This treatment can decrease chances of cirrhosis, and or liver cancer.

THE OTHER HEPATITIS:

Hepatitis D; This hepatitis only occurs in people who have hepatitis B, it depends on the replication of hepatitis B. It can not reproduce it self-alone. This disease usually develops in a chronic state. It is passed by blood to blood and can only be diagnosed by a blood test.

Hepatitis E; A self-limited virus that may occur after a natural disaster because of the fecal contaminated water and food. There is no blood test for this strain. It is transmitted fecal oral.

As you can see as a health professional, hepatitis is everywhere, it is deadly and only you can protect your self and your patients..

Stay alive and healthy we need you here. God Bless You.

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