Hepatitis
A. Description
1. Inflammation of the liver caused by a virus, bacteria, or exposure to
medications or hepatotoxins.
2. The goals of treatment include resting the inflamed liver to reduce
metabolic demands and increasing the blood supply, thus promoting
cellular regeneration and preventing complications.
B. Types of hepatitis include hepatitis A virus (HAV), hepatitis B virus
(HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E
virus (HEV).
C. Assessment and stages of viral hepatitis
1. Pre-icteric Stage
The first stage of hepatitis, preceding the appearance of jaundice;
includes flulike symptoms—malaise, fatigue; anorexia, nausea,
vomiting, diarrhea; pain—headache, muscle aches, polyarthritis; and
elevated serum bilirubin and enzyme levels.
2. Icteric Stage
The second stage of hepatitis; includes the appearance of jaundice
and associated symptoms such as elevated bilirubin levels, dark or
tea-colored urine, and clay-colored stools; pruritus; and a decrease in
preicteric-phase symptoms.
3. Posticteric Stage
The convalescent stage of hepatitis, in which the jaundice decreases
and the color of the urine and stool returns to normal; energy
increases, pain subsides, there is minimal to
absent gastrointestinal symptoms, and bilirubin and enzyme levels
return to normal.
Hepatitis A
A. Description: Formerly known as infectious hepatitis
,B. Individuals at increased risk
1. Crowded conditions (e.g., day care, nursing home)
2. Exposure to poor sanitation
C. Transmission
1. Fecal-oral route
2. Person-to-person contact
3. Parenteral
4. Contaminated fruits or vegetables, or uncooked shellfish
5. Contaminated water or milk
6. Poorly washed utensils
D. Incubation and infectious period
1. Incubation period is 2 to 6 weeks.
2. Infectious period is 2 to 3 weeks before and 1 week after
development of jaundice.
E. Testing
1. Infection is established by the presence of HAV antibodies (anti-
HAV) in the blood.
2. ImmunoglobulinM (IgM) and immunoglobulin G (IgG) are normally
present in the blood,
and increased levels indicate infection and inflammation.
3. Ongoing inflammation of the liver is evidenced by the presence of
elevated levels of IgM antibodies, which persist in the blood for 4 to 6
weeks.
4. Previous infection is indicated by the presence of elevated levels of
IgG antibodies.
F. Complication: Fulminant (severe acute and often fatal) hepatitis
G. Prevention
, 1. Strict hand washing
2. Stool and needle precautions
3. Treatment of municipal water supplies
4. Serological screening of food handlers
5. Hepatitis A vaccine: Two doses are needed at least 6 months apart
for lasting protection. For additional information, refer to
http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-a.html
6. Immunoglobulin: For individuals exposed to HAV who have never
received the hepatitis A vaccine;
administer immune globulin during the period of incubation and within
2 weeks of exposure.
7. Immune globulin and hepatitis A vaccine are recommended for
household members and sexual contacts of individuals with hepatitis
A.
8. Preexposure prophylaxis with immune globulin is recommended to
individuals traveling to countries with poor or uncertain sanitation
conditions.
Hepatitis B
A. Description
1. Hepatitis B is nonseasonal.
2. All age groups can be affected.
B. Individuals at increased risk
1. IV drug users
2. Clients undergoing long-term hemodialysis
3. Health care personnel
C. Transmission
1. Blood or body fluid contact
A. Description
1. Inflammation of the liver caused by a virus, bacteria, or exposure to
medications or hepatotoxins.
2. The goals of treatment include resting the inflamed liver to reduce
metabolic demands and increasing the blood supply, thus promoting
cellular regeneration and preventing complications.
B. Types of hepatitis include hepatitis A virus (HAV), hepatitis B virus
(HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E
virus (HEV).
C. Assessment and stages of viral hepatitis
1. Pre-icteric Stage
The first stage of hepatitis, preceding the appearance of jaundice;
includes flulike symptoms—malaise, fatigue; anorexia, nausea,
vomiting, diarrhea; pain—headache, muscle aches, polyarthritis; and
elevated serum bilirubin and enzyme levels.
2. Icteric Stage
The second stage of hepatitis; includes the appearance of jaundice
and associated symptoms such as elevated bilirubin levels, dark or
tea-colored urine, and clay-colored stools; pruritus; and a decrease in
preicteric-phase symptoms.
3. Posticteric Stage
The convalescent stage of hepatitis, in which the jaundice decreases
and the color of the urine and stool returns to normal; energy
increases, pain subsides, there is minimal to
absent gastrointestinal symptoms, and bilirubin and enzyme levels
return to normal.
Hepatitis A
A. Description: Formerly known as infectious hepatitis
,B. Individuals at increased risk
1. Crowded conditions (e.g., day care, nursing home)
2. Exposure to poor sanitation
C. Transmission
1. Fecal-oral route
2. Person-to-person contact
3. Parenteral
4. Contaminated fruits or vegetables, or uncooked shellfish
5. Contaminated water or milk
6. Poorly washed utensils
D. Incubation and infectious period
1. Incubation period is 2 to 6 weeks.
2. Infectious period is 2 to 3 weeks before and 1 week after
development of jaundice.
E. Testing
1. Infection is established by the presence of HAV antibodies (anti-
HAV) in the blood.
2. ImmunoglobulinM (IgM) and immunoglobulin G (IgG) are normally
present in the blood,
and increased levels indicate infection and inflammation.
3. Ongoing inflammation of the liver is evidenced by the presence of
elevated levels of IgM antibodies, which persist in the blood for 4 to 6
weeks.
4. Previous infection is indicated by the presence of elevated levels of
IgG antibodies.
F. Complication: Fulminant (severe acute and often fatal) hepatitis
G. Prevention
, 1. Strict hand washing
2. Stool and needle precautions
3. Treatment of municipal water supplies
4. Serological screening of food handlers
5. Hepatitis A vaccine: Two doses are needed at least 6 months apart
for lasting protection. For additional information, refer to
http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-a.html
6. Immunoglobulin: For individuals exposed to HAV who have never
received the hepatitis A vaccine;
administer immune globulin during the period of incubation and within
2 weeks of exposure.
7. Immune globulin and hepatitis A vaccine are recommended for
household members and sexual contacts of individuals with hepatitis
A.
8. Preexposure prophylaxis with immune globulin is recommended to
individuals traveling to countries with poor or uncertain sanitation
conditions.
Hepatitis B
A. Description
1. Hepatitis B is nonseasonal.
2. All age groups can be affected.
B. Individuals at increased risk
1. IV drug users
2. Clients undergoing long-term hemodialysis
3. Health care personnel
C. Transmission
1. Blood or body fluid contact
