Module 12

Hepatitis causes

• Inflammation of the liver

• Viral, alcohol, medications, chemicals, autoimmune diseases, metabolic problems

Hepatitis A

• Contaminated food and water

• Prevented with improved hygiene and vaccines

• No tx

Hepatitis B

• Contact with bodily fluids

• Prevented with blood screening, improved hygiene and vaccines

• Tx nucleostide analogs pegylated interferon

Hepatitis C

• iv drug use; unsterilized medical equipment

• prevented with blood screening, sterile needles, sanitary healthcare settings

• Tx direct acting antiviral agents

Hepatitis D

• Contact with infected blood

• Prevented with blood screening, sterile needles, safe sex

• Chronic tx—interferon

Hepatitis E

• oral-fecal route; drinking contaminated water

• prevented with improved hygiene, avoiding uncooked shellfish, fruits, and veggies

• Tx ribavirin (antiviral)

Hepatitis clinical manifestations

• many are asymptomatic

• anorexia, n/v

• malaise, fatigue, lethargy

• muscle and joint pain

• RUQ tenderness

Hepatitis recovery

• most recover completely with no complications

• Some HBV, and most HCV result in chronic hepatitis

Hepatitis complications

• acute liver failure

• Chronic hepatitis

• Cirrhosis

• Portal hypertension

• Liver cancer

• Hepatic encephalopathy

• ascites

Hepatitis Interprofessional Care

• adequate nutrition

• Rest

• Avoid alcohol

• Notify sexual partners

• Health promotion

Chronic Hepatitis B Care

• drug therapy focuses on decreasing viral load, liver enzyme levels, and rate of disease progression

• Prevent cirrhosis, portal hypertension, liver failure, and cancer

• Nucleoside and nucleotide analogs

Hepatitis A and E drug therapy

• Antihistamines and antiemetics

Hepatitis B and D

• Interferon

Hepatitis C drug therapy

• DAAs

• Protease inhibitors NS5A inhibitors, polymerase inhibitors

Hepatitis Nursing case

• Assess for jaundice, provide comfort measures

• Small frequent meals, carbonated beverage, adequate fluid intake

• Plan activities after periods of rest

• Teach prevention of transmission

• No alcohol

• No blood donation by Hep B and C

Cirrhosis causes

• End stage liver disease, usually happens after decades of chronic liver disease

• Most common Hep C and alcohol induced liver disease

Cirrhosis clinical manifestations

• Few symptoms in early stages

• fatigue and enlarged liver

• Jaundice, peripheral edema, ascites

• Skin lesions

Cirrhosis objective data

• fever, wasting extremities

• Spider angiomas, palmar erythema

• Abd distention, ascites

• Palpable liver and spleen

• Foul breath

• Hematemesis; black tarry stools

Cirrhosis diagnostic tests

• ALT and AST

• Total protein, albumin levels

• Serum bilirubin, globulin levels

• Cholesterol

• PT time

• Fibroscan

• Liver biopsy

Cirrhosis ascites tx

• sodium restriction

• diuretics, fluid removal

• albumin

• paracentesis

Cirrhosis interprofessional care

• Shunting procedures

• Nonselective B-blocker

• Balloon tamponade

Cirrhosis nursing management

• Diet high in calories and carbs

• Treat alcoholism

• Identify and treat acute hepatitis

• Rest , relief of dyspnea

• ROM, cough/deep breathing exercises

Non Alcoholic Steatohepatitis (NASH)

• Resembles alcoholic liver disease, but occurs in people who drink little or no alcohol

• Fat in the liver, along with inflammation and damage

• Few or no symptoms until significant damage

• No specific therapies

Acute pancreatitis clinical manifestations

• LUQ or mid-epigastric and radiates to back

• Sudden onset

• Deep, piercing, continuous, or steady

• Eating worsens pain

• Starts when recumbent

• Not relieved with vomiting

Chronic pancreatitis causes

• alcohol

• Gallstones

• Penetrating trauma

• Steroids

• Autoimmune pancreatitis

• Cystic fibrosis

Acute pancreatitis interprofessional care

• Lactated Ringer’s solution

• Prevent infection

• Pain management

• Minimiza pancreatic stimulation—NPO, NG suction

Chronic Pancreatitis Interprofessional care

• no smoking, alcohol, or caffeine

• enzyme replacement

• bile salts

• acid neutralizing and acid inhibiting drugs

• endoscopic procedures