Hepatitis, Non-alcoholic fatty liver disease, cirrhosis of the liver

What are the RF of Hep A?

• Poor hygiene or sanitary conditions, improper food handling

• crowded situations, homelessness

• Drug users

• MSM

• Travellers

What is the mode of transmission of Hep A?

Oral-fecal route

What are nursing considerations for Hep A?

• Meticulous hand-washing after seeing pt

• Report condition to DOH

• Monitor: for jaundice, stool/urine changes, abdominal changes, bleeding, LFTs

How can Hep A be prevented?

• Get vaccinated

  • ensure immunity prior to travelling

• Practice good hygiene, safe sex, and environmental sanitation

• Get screened if high-risk

• screening of food-handlers

Who should be screened for Hep-A?

• high risk patients

• people who work in restaurants or handling food

• people who have travelled out of the country

What education should be provided about Hep A?

• Importance of hand-washing before eating and after using the bathroom

• Importance of vaccines

What are the RF for Hep B?

• MSM, unprotected sex

• People who liver w/chronically infected people

• pts on hemodialysis

• healthcare or public safety personnel

• blood product recipient

• prisoners, veterans, homeless pts

What is the mode of transmission of Hep B?

Blood, semen, or saliva route

What are nursing considerations for Hep B?

• use infection control precautions, handle all blood as potentially infective

• dispose of needles properly, use needles devices when available

• Monitor: for jaundice, urine/stool changes, abdominal changes, bleeding, LFTs

How can Hep B be prevented?

• Screening donated blood

• Using disposable needles/syringes

• practicing safe sex and proper hygiene

• Immunization

• avoid sharing razors or toothbrushes

How can Hep B be screened for?

• screen high-risk individuals for:

  • HBsAG

  • anti-HBs (indicates immunity)

  • Anti-HBC

What teachings should be provided about Hep B?

• educate about good hygienic practices, hand washing

• use gloves when expecting contact with blood

• do not share personal items like razors or toothbrushes

• use condoms

What are RF for Hep C?

• Baby boomer aged people (1945-1965)

• IV drug users, tattoos, need use

• Blood transfusions prior to 1992

• high-risk sexual behavior, MSM

• Occupational exposure

• hemodialysis

What is the mode of transmission for Hep C?

Percutaneous transmission (through break in the skin)

What are specific nursing considerations for Hep B?

• use infection control precautions, treat all blood as potentially infective

• dispose of needles properly, use needless devices when available

• Use antivirals

• Monitor: for jaundice, stool/urine changes, abdominal changes, bleeding, LFTs

How can Hep C be prevented?

• Screening of blood or tissue donations

• Using infection control precautions

• modifying high-risk behavior

Who should be screened for Hep C?

• Baby boomers

• people with tattoos

• IV drug users

What teaching should be provided about Hep C?

• Prevention methods

• Screening

• No vaccination

What is non-alcoholic fatty liver disease?

Inflammation and scarring that result from fat accumulation in the liver

What is the etiology of Non-alcoholic fatty liver disease?

Accumulation of excess fat in the hepatocytes leads to fibrosis and eventually cirrhosis

What are RF for non-alcoholic fatty liver disease?

• abdominal obesity

• diabetes

• metabolic syndrome

  • obesity

  • hypertriglyceridemia

  • low HDL

  • hypertension

  • hyperglycemia

What is the treatment for non-alcoholic fatty liver disease?

• reduction of risk factors

• losing at least 10% of body weight

  • if overweight or obese

• Exercise

• bariatric surgery if indicated

What is cirrhosis of the liver?

End stage liver disease

What is the pathophysiology of liver cirrhosis?

• Liver cells try to regenerate → abnormal blood vessels and bile duct architecture results.

• overgrowth of fibrous connective tissue distorts the livers normal structure, → irregular lobules and impeded blood flow

• impaired liver regeneration + poor cell nutrition + hypoxia → decreased liver function

What are early clinical manifestations for liver cirrhosis?

• fatigue

• enlarged liver

• Normal LFTs

What are the later neuro clinical manifestations of liver cirrhosis?

• Hepatic encephalopathy

• Peripheral neuropathy

• Asterixis

What are the later GI manifestations of liver cirrhosis?

• Anorexia, weight loss

• dyspepsia, n/v, fecal-smelling breath (fetor hepaticus)

• change in bowel habits, hematemesis

• Varices: esophageal, gastric, hemorrhoidal

• Elevated LFTs, hepatomegaly

What are the later reproductive clinical manifestations of liver cirrhosis?

• Amenorrhea, Vaginal bleeding

• testicular atrophy, loss of axillary/pubic hair, impotence

• gyneocomastia

What are the integumentary clinical manifestations of liver cirrhosis?

• jaundice

• spider angioma

• palmar erythema

• purpura, petechiae, bruising

• caput medusae

what are the later hematologic clinical manifestations of liver cirrhosis?

• Anemia

• thrombocytpenia, leukopenia

• coag disorders

• splenomegaly

• bleeding

What are later metabolic clinical manifestations of liver cirrhosis?

• hypokalemia

• hyponatremia

• hypoalbuminemia

what are later cv clinical manifestations of liver cirrhosis?

• Portal HTN

• esophageal and gastric varices

• peripheral edema, ascites

• hepatic encephalopathy, asterixis

• anorexia