Hepatitis

A,B, C, D, E
Presented by:

Kim Loid O. Bagatua

Kyle M. Gaspar

Lou T. Recamara
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 What is a
Hepatitis?
● Hepatitis (inflammation and infection of the liver) is caused by hepatitis
A, B, C, D, or E viruses.
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 TABLE OF CONTENTS.
01 | Hepatitis 02 | Hepatitis 03 | Hepatitis
A B C

04 | Hepatitis 05 | Hepatitis
D E
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 Hepatitis A
Type A occurs in children of all ages and accounts for approximately 30%
of cases.
• Virus that infects and causes liver inflammation.
• Period of communicability: Highest during 2 weeks preceding onset of
symptoms
• Causative agent: A picornavirus, hepatitis A virus (HAV)
• Risk factors: Foreign travel, inaccessibility to clean water
• Epidemiology: Affects an estimated 1.5 million people worldwide each
year.
• Incubation period: 25 days on average
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 ● Mode of transmission: In children, ingestion of fecally contaminated water or
shellfish: day care center spread from contaminated changing tables. Humans are
only reservoir. Fecal-oral route (contaminated food/water, close contact)

● Immunity: Natural; one episode induces immunity for the specific type of virus

● Active artificial immunity: HAV vaccine (recommended for workers in day care
center); expected to be required for children in the future.

● Passive artificial immunity: Immune globulin

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 Pathophysiology

● Virus attaches to and enters into hepatocytes. Hepatocytes are only cell type where
viral replication occurs.

● Host immune response leads to inflammation and damage to hepatocytes.

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 Signs and Symptoms
Symptoms with hepatitis A are generally mild. Jaundice occurs as liver function
slows. This last for approximately a week, then symptoms fade with full recovery.
• Fatigue
• Nausea and vomiting
• Abdominal pain or discomfort
• Loss of appetite
• Dark urine
• Clay-colored stools
• Joint pain
• Jaundice (yellowing of the skin and eyes)
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 Therapeutic Management
Strict hand washing infection control precautions are mandatory when
caring for children with hepatitis.

Feces must be disposed of carefully because the type a virus may be

cultured from feces. The treatment for hepatitis A is increased rest
and maintenance of a good calorie intake, a low fat diet .

Children are generally hungrier at breakfast than later in the day, so

encourage them to eat a healthier breakfast. Children can be cared
for at home, they should not return to school or a day care center
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until 2 weeks after the onset of symptoms.

 Hepatitis B
Hepatitis B is a viral infection that attacks the liver, and can cause both,
acute and chronic disease. Transmission happens from mother to child
during birth and delivery. In highly endemic areas, hepatitis B can spread
horizontal transmission, especially from an infected child to an uninfected
child during the first 5 years of life. That’s why, in many country, newborns
are vaccinated on Hepatitis B. Hepatitis B can be almost 100% prevented by
vaccines, that are safe, available and effective.
Hepatitis B tends to occur in adolescents after intimate contact or the use of
contaminated syringes for drug injection; it accounts for approximately 40%
of hepatitis infections (Tung, 2003).
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 • Causative agent: A hepadnavirus; hepatitis B virus (HBV)
• Incubation period: 120 days on average
• Period of communicability: Later part of incubation period and during the acute
stage
• Mode of transmission: Transfusion of contaminated syringe or needle through
IV drug use; may be spread to fetus if mother has infection in the third trimester of
pregnancy.
• Immunity: Natural; one episode induces immunity for the specific type of virus.
• Artificial active immunity: Vaccine for the HBV virus (recommended for routine
immunization series and health care providers)
• Passive artificial immunity: Specific hepatitis B immune serum globulin.
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 Signs and Symptoms
• Symptoms of hepatitis B are more marked. Children report generalized aching,
right upper quadrant pain, and headache. They may have a low grade fever. They
feel ill; they are irritable and fretful from pruritus. After 3-7 days of such
symptoms, the color of the urine becomes darker (brown) because of the
excretion of bilirubin. In another 2 days, the sclerae become jaundice; soon the
child has generalized jaundice. With the generalized jaundice, there is little
excretion of bilirubin into the stool, so the stools become white or gray.
• Elevations of AST and serum alanine transaminase (ALT; serum glutamate
pyruvate transaminase.
• Levels of bilirubin are increased and bile pigments in the stool are decreased.
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 Therapeutic Management
• Syringes and needles must be disposed of with caution because the type B virus can be
transmitted by blood.
• Contacts should receive hepatitis B immune globulin (HBIG) as appropriate (Humiston &
Marshall, 2004)
• Children should receive routine immunization against HBV. All women should be screened
during pregnancy for hepatitis B surface antigen (HBsAg).
• Infants born to hepatitis-positive mother receive both HBIG and active immunization at birth to
prevent them from contracting the disease.
• Lamivudine (Epivir), an antiviral agent, may be effective in reducing viral replication with
hepatitis B. Interferon also may be prescribed. Of those with type B, 90% will recover
completely, but 10% will develop chronic hepatitis and become hepatitis carriers. Infants who
contracted the disease at birth have an increase risk for liver carcinoma later in life.
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 Hepatitis C
Hepatitis C is a viral infection that can cause liver inflammation and
damage. It is caused by the hepatitis C virus (HCV). The hepatitis C virus
is a bloodborne virus and most infection occur through exposure to blood
from unsafe injection practices, unsafe health care, unscreened blood
transfusions, injection drug use and sexual practices that lead to exposure
to blood. HCV can be transmitted from an infected mother to the child
during both pregnancy and childbirth. HCV-infected mothers transmit
their infection to their baby in 5.8% of pregnancies; the risk of
transmission is higher if the mother is co-infected with HIV.
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 Other possible modes of transmission of hepatitis C in children
include:
• Blood transfusions or organ transplants from infected donors.
• Use of contaminated medical equipment, such as needles or
syringes, during medical procedures or tattoos.
• Sharing personal hygiene items, such as toothbrushes or
razors, with an infected person.
• Unprotected sexual contact with an infected person (rare in
children).
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 The incubation period for hepatitis C ranges from 2 weeks to
6 months. Following initial infection, approximately 80% of
people do not exhibit any symptoms. Those who are acutely
symptomatic may exhibit the following symptoms:
• Fatigue
• Fever
• Abdominal pain
• Joint pain
• Itchy skin
• Dark urine
• Jaundice
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 Hepatitis D
Hepatitis D is an inflammation of the liver caused by the hepatitis D virus
(HDV), which requires HBV for its replication. Hepatitis D infection
cannot occur in the absence of hepatitis B virus. HDV-HBV co-infection
is considered the most severe form of chronic viral hepatitis due to more
rapid progression towards hepatocellular carcinoma and liver-related
death. Disease symptoms are mild, but there is a high incidence of
fulminant hepatitis after the initial infection. The hepatitis D virus can
cause an acute or chronic infection, or both.
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 Mode of transmission
HDV is transmitted by the same methods as HBV: exposure to infected blood and
serous body fluids; and contaminated needles, syringes, blood and plasma product
transfusions. Sexual transmission may also occur but is less common than with
HBV.

Hepatitis D and hepatitis B infections may occur together as a coinfection or a

superinfection.
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 Coinfection
A coinfection occurs when you get both hepatitis D and hepatitis B infections at the
same time. Coinfections usually cause acute, or short-term, hepatitis D and B
infections. Coinfections may cause severe acute hepatitis.

Superinfection
A superinfection occurs if you already have chronic hepatitis B and then become
infected with hepatitis D. When you get a superinfection, you may have severe acute
hepatitis symptoms.
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 There’s currently no cure or vaccine for hepatitis D, but it can be
prevented in people who aren’t already infected with hepatitis B.
Vaccination against hepatitis B is the only method to prevent HDV
infection.
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 Signs and Symptoms
• Yellowing of the skin and eyes (jaundice
• Joint pain
• Abdominal pain
• Vomiting
• Loss of appetite
• Darkk urine
• Fatigue
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 Hepatitis E

The virus responsible for the infection is called the Hepatitis E

virus (HEV), and it is transmitted through the consumption of
contaminated food or water.
Many people with hepatitis E do not have symptoms of acute
infection.
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 • Epidemiology: It is difficult to determine the exact prevalence of
Hepatitis E worldwide, as many cases go undiagnosed or unreported.
there are an estimated 20 million Hepatitis E infections and over 3
million symptomatic cases annually worldwide. is extremely rare in
children.
• Incubation period: 1 week prior to onset to 30 days after the onset of
jaundice
• Mode of transmission: HEV is usually spread by the fecal-oral route.
In developing countries, the most common source of HEV infection is
contaminated drinking water.
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 Pathophysiology

• These symptoms are a result of the inflammation and damage to the

liver cells, as well as the body's immune response to the infection
• The body's immune system responds to the viral infection by activating
immune cells such as T cells, B cells, and natural killer cells. The
immune response is essential for clearing the virus from the body, but it
can also contribute to liver damage.
• The Hepatitis E virus enters the body through the oral route, primarily
by consumption of contaminated water or food. The virus then travels to
the liver, where it infects hepatocytes (liver cells).
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 Signs and Symptoms
• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Jaundice
• Dark urine
• Clay-colored stool
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• Joint pain
 Therapeutic Management

Good hygiene practices, such as washing hands regularly and

avoiding contaminated water and food, can help reduce the
risk of infection. In areas where Hepatitis E is endemic, the
provision of safe drinking water and improved sanitation and
hygiene practices can also help prevent the spread of the virus.
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 DIAGNOSIS
Liver Biopsy
Physical Exam
Blood Test
Imaging Tests
Ultrasound
MRI and CT Scans
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 Liver biopsy Blood Test
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 Nursing Diagnosis
• Pain related to pruritus of jaundice and liver
inflammation
• Risk for infection
• Imbalanced Nutrition: Less Than Body
Requirements
• Risk for Deficient Fluid Volume
• Fatigue
• Risk for Impaired Skin Integrity
• Deficient Knowledge
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 Nursing Interventions

1. 1. Establish isolation techniques for enteric and respiratory infections

according to infection guidelines and policy. Encourage or model effective
handwashing.
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 Prevents transmission of viral disease to others. Thorough hand washing
is effective in preventing virus transmission. Types A and E are
transmitted by oral-fecal route, contaminated water, milk, and food
(especially inadequately cooked shellfish). Types A, B, C, and D are
transmitted by contaminated blood/blood products; needle punctures;
open wounds; and contact with saliva, urine, stool, and semen. Incidence
of both hepatitis B virus (HBV) and hepatitis C virus (HCV) has increased
among healthcare providers and high-risk patients. Toxic and alcoholic
hepatitis are not communicable and do not require special measures and
isolation.
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 2. Stress need to monitor and restrict visitors as indicated.

Patient exposure to infectious processes (especially respiratory)

potentiates risk of secondary complications.
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 3. Explain isolation procedures to patient and SO.

Understanding reasons for safeguarding themselves and

others can lessen feelings of isolation and stigmatization.
Isolation may last 2–3 wk from onset of illness, depending on
type or duration of symptoms.
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 4. Give information regarding availability of gamma
globulin, ISG, H-BIG, HB vaccine (Recombivax HB,
Engerix-B) through health department or family physician.

Immunoglobulins may be effective in preventing viral hepatitis

in those who have been exposed, depending on type of hepatitis
and period of incubation.
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 5. Administer medications as indicated:
 5.1. Antiviral drugs: vidarabine (Vira-A), acyclovir
(Zovirax)
Useful in treating chronic active hepatitis.
 5.2. Interferon alfa-2b (Intron A)
Treats the symptoms of hepatitis C and may lead to a
temporary improvement in liver function.
 5.3. Ribavirin
Used in conjunction with interferon to improve the
effectiveness of that drug. Note: These treatments lead to
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improvement, not cure of the disease.

 That’s all,
THANK YOU!
Do you have any questions?
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