1. HEPATITIS B and c VIRUS (HBV)

2. Hepatitis
Definition and cause: Hepatitis is an inflammation of the liver which is caused by viral hepatitis, resulting from six major viruses A, B, C, D, E, and G.

3. HEPATITIS B VIRUS (HBV)
hepatitis B is transmitted primarily through blood.
HBV has been found in blood, saliva, semen, and vaginal secretions and can be transmitted through mucous membranes and breaks in the skin. HBV is also transferred from carrier mothers to their babies

4. Hepatitis B virus: Transmission is through
Mothers infected with HBV
Unsafe injections and transfusions
Sexual activity (homosexuals and hetrosexuals)

5. Pathophysiology of hepatitis
The pathophysiologic changes in the various types of viral hepatitis are similar. During acute infection, liver damage is mediated by cytotoxic cytokines and natural killer cells that cause lysis of infected liver cells. Liver damage results from hepatic cell necrosis. With time, liver cells can regenerate, and in absence of complications, they should restore their normal appearance and function.

6. Risk Factors for Hepatitis B
• Frequent exposure to blood, blood products, or other body fluids
• Health care workers
• Hemodialysis
• Male homosexual
• IV/injection drug use
• Close contact with carrier of HBV
• Travel to or residence in area with uncertain sanitary conditions
• Multiple sexual partners
• Recent history of sexually transmitted disease(SITD)
• Receipt of blood or blood products (eg, clotting factor concentrate)

7. Clinical Manifestations
Signs and symptoms of hepatitis B may be insidious and variable:
Fever and respiratory symptoms are rare
some patients have arthralgias and rashes.
loss of appetite,
dyspepsia,
abdominal pain,
generalized aching,
malaise, and weakness.

8. Jaundice may or may not be evident
Jaundice may or may not be evident. If jaundice occurs, light-colored stools and dark urine accompany it.
The liver may be tender and enlarged to 12 to 14 cm vertically. The spleen is enlarged and palpable. in a few patients; the posterior cervical lymph nodes may also be enlarged.

9. Assessment and Diagnostic Findings
HBV is a DNA virus composed of the following antigenic particles:
• HBcAg—hepatitis B core antigen (antigenic material in an inner core)
• HBsAg—hepatitis B surface antigen (antigenic material on surface of HBV)

10. Each antigen elicits its specific antibody and is a marker for different stages of the disease process:
• anti-HBc—antibody to core antigen or HBV; persists during the acute phase of illness; may indicate continuing HBV in the liver
• anti-HBs—antibody to surface determinants on HBV; detected during late convalescence; usually indicates recovery
and development of immunity

11. Bilirubin (serum and urinary): ↑
Prothrombine time: Prolonged.
Serum proteins: Normal or ↑

12. Prevention
The goals of prevention are to interrupt the chain of transmission, to protect people at high risk with active immunization through the use of hepatitis B vaccine, and to use passive immunization for unprotected people exposed to HBV.

13. PREVENTING TRANSMISSION
Continued screening of blood donors for the presence of hepatitis B antigens will further decrease the risk of transmission by blood transfusion.

14. ACTIVE IMMUNIZATION: HEPATITIS B VACCINE
Active immunization is recommended for:
1)individuals at high risk for hepatitis B (eg, health care personnel and hemodialysis patients).
2)individuals with hepatitis C and other chronic liver diseases should receive the vaccine

15. Medical Management
The goals of treatment are to minimize infectivity, normalize liver inflammation, and decrease symptoms.
1. Of all the agents that have been used to treat chronic type B viral hepatitis, alpha interferon as the single modality of therapy offers the most promise.
2. Two antiviral agents (lamivudine [Epvir] and adefovir [Hepsera]) have been approved for use in chronic hepatitis B.

16. Avoid alcohol and drugs detoxified by the liver
3.Bed rest may be recommended, regardless of other treatment, until the symptoms of hepatitis have subsided
4. Adequate nutrition should be maintained; proteins are restricted when the liver’s ability to protein by products is impaired
metabolize
Avoid alcohol and drugs detoxified by the liver
↑ calorie,↑ carbohydrates, vitamins, and ↓fat

17. Nursing Management
Convalescence may be prolonged, with complete symptomatic
recovery sometimes requiring 3 to 4 months or longer. During
this stage, gradual resumption of physical activity is encouraged after the jaundice has resolved.
The nurse identifies psychosocial issues and concerns, particularly the effects of separation from family and friends if the patient is hospitalized during the acute and infective stages. .

18. Even if not hospitalized, the patient will be unable to work and must avoid sexual contact.
Planning is required to minimize alterations in sensory perception.
Planning that includes the family helps to decrease their fears and anxieties about the spread of the disease

19. HEPATITIS C VIRUS (HCV)
Hepatitis C virus: Transmission is through
.Contaminated needles
.Blood transfusion
.Sexual activity
HCV is the underlying cause of about one-third of cases
of hepatocellular carcinoma, and it is the most common reason for liver transplantation

20. Risk Factors for Hepatitis C
• Recipient of blood products or organ transplant
• Health care and public safety workers after needlestick injuries or mucosal exposure to blood
• Children born to women infected with hepatitis C virus
• IV/injection drug use
• Past treatment with chronic hemodialysis
• Sex with infected partner, having multiple sex partners, history of STD, unprotected sex

21. Collaborative care for viral hepatitis
There is no specific treatment for acute viral hepatitis. Patients can be managed at home. Rest and well-balanced diet may be the most beneficial for liver cell regeneration and healing.
In chronic hepatitis B & C, follow the above mentioned instructions and administer prescribed medications (α-interferon & lamivudine, ribavirin).
Observe side affects of α-interferon (arthralgia, myalgia, fatigue, headache, fever, nausea, anorexia) and ribavirin (anemia, anorexia, cough, dyspnea, insomnia, bruritus).

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