Hepatitis

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Hepatitis
By Stephanie Licano
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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

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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.
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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

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Hepatitis A

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

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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 28-160
  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.

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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 15-150 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.

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

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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.

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Basic Treatment

• Supportive therapy for existing signs and
  symptoms and preventing the transmission of the
  disease are important in the 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.

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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)

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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. 20-30 of patients will
  develop cirrhosis by the 5th 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 IOs
• Emotional support and teaching the patient and
  the family is also very essential

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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.

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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.

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Liver Abscesses

• Another presentation by
• Stephanie Licano

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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

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Another way to diagnose

• Radiograph
• CT scan
• Ultrasound
• Liver scan
• Lab exam of antigen-antibody reaction of amebae
  in the serum

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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.

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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.