GI & Nutrition - Hepatitis

What is the location of the liver?

RUQ

sits on top of the stomach

prior to what procedure will you be assessing the RUQ for?

liver biopsy

What does a liver biopsy put a pt at risk for?

bleeding - during or post

\
d/t the liver being vascular

what are the functions of the liver?

detoxifies

blood clotting

albumin production

What does the liver detoxify?

ammonia to urea

What drugs are very toxic to the liver?

§  Acetaminophen (Tylenol)

§  Mycins – ex. Vancomycin

§  Alcohol – causes liver damage

how does jaundice occur?

If the liver is not working properly and it cannot pick up the bilirubin and place it in the bile, the bilirubin will __accumulate in the body and sit on the pt’s skin__

how can you know if the pt has jaundice?

you will see yellow skin and sclera

what gives urine its yellow color and stool its brown color?

bilirubin

what happens if the liver does not pick up the bilirubin and places it in the duodenum?

the kidneys will pick it up causing the pt to have dark urine

what color will the stool be if the pt is not excreting bilirubin thru stool?

pale or clay color

to check for jaundice in pt’s with a darker complexion, what will you assess?

sclera of the eyes and the mucus membrane such as the gums of the mouth

if the pt has jaundice what labs will you see?

elevated liver enzymes (ALT + AST)

what is hepatitis?

Inflammation of the liver

what are the causes of hepatitis?

viral (most common)

Toxin induced

what is viral hepatitis?

·      Hepatitis A – E

\
·      Hepatocytes become targets of the virus from direct action (HCV) or through cell-mediated immune response to virus (HBV & HCV)

what is Toxin induced hepatitis?

·      d/t alcohol

·      medications such as Acetaminophen and mycins (ex. Vancomycin)

what is the route of transmission of hep. A?

fecal and oral

what is an example of route of transmission for hep A?

·      Contaminated food such as __shellfish__

o   d/t sewage being drained into the sea where bottom feeders live

\
\
·      Contact with infected stool

o   poor hygiene, incontinent individuals, or sexual activity

where is hep. A most common?

daycares

what are the S/S of hep.A?

·      Mild flu like s/s – fever, headache

·      Jaundice – yellow skin, sclera, mucus membranes

NOTE: Not all pt’s will have jaundice

\

when is the risk for transmission of hep. A the highest?

before the S/S begin

how will you treat hep A?

hep. A vaccine (given at age 1)

recommend vax post exposure

HAV immunization

proper handwashing

pt comes in with hep.A but states they are allergic to the vaccine. how will you treat the pt?

recommend immunoglobins

what type of pts will benefit from immunoglobins who have contracted hep.A?

o   Pts 40+ years of age

o   12 months or younger

o   Pt’s with chronic liver disease

o   Immunosuppressed pt’s

o   Pt’s who are allergic to the vaccine

what is the route of transmission for hep. B?

blood and bodily fluids

how is hep.B contracted?

·      Needles d/t substance abuse

·      Blood products and organ transplants

·      Contaminated needle sticks

·      Unsanitary tattoo equipment

·      Anal sex

·      Unprotected sexual contact

if hep.B is acute how will you treat ur pt?

provide supportive care for flu like s/s

offer vaccine

if hep.B is d/t a chronic infection how will you treat ur pt?

o   Administer antiviral meds for life

o   No cure for chronic

\

what are pts with chronic hep.b at risk for?

liver cancer

who is at risk for contracting hep.B?

healthcare workers

what is the route of transmission for hep C?

blood and bodily fluids

\
\*NOTE: Same as Hep B

how is hep.C contracted?

·      Sharing needles

·      Dirty tattoo needles

·      High risk sexual behavior

·      Anal sex

·      Blood transfusions – if done prior to the year 1992 (d/t poor screening)

when will the S/S appear for a pt with chronic hep C?

15-20 years

will have manifestations of liver damage

what is the cure for hep C?

·      Combination therapy (Peginterferon alfa-2a and Ribavirin – antivirals for 12 weeks)

·      Avoid risk taking behaviors

\
NO VACCINE!

what is the Route of transmission for hep.D?

Blood

\

in order to contract hep.D what must be present?

active hep.B infection in order to replicate

how is hep.D contracted?

·      Sharing needles

·      Blood products and organ transplants

·      Contaminated needles

·      Unsanitary tattoo equipment

·      Sexual contact

what are the S/S of hep.D?

They range from asymptomatic to acute liver failure

what is the treatment for hep.D?

Individuals can immunize against HBV to reduce risk for co-infection

\
\
no vaccine available

what is the route of transmission for hep.E?

fecal oral

\
NOTE: same as hep.A

what is an example of contracting hep.E?

·      Drinking contaminated water (developing countries)

what are the S/S of hep.E?

·      Acute and self-resolving (Manage s/s and let it run its course)

·      Can be chronic in pts who are immunocompromised

·      10% increased mortality rate in pregnant women

which types of viral hepatitis have a vaccine?

Hep A

Hep B

which types of viral hepatitis do not have a vaccine?

Hep C

Hep D

Hep E

which type of viral hepatitis can be cured?

hep.C

what is the patho of hepatitis?

The cells in the liver are being destroyed

\
§  Temporary altered:

·      Bile metabolism

·      Detoxification of meds

what is acute hep?

the inflammation will resolve eventually (temp)

\
Liver resumes normal appearance and function

what are the s/s of acute hep?

typically no S/S but can be -

o   Mild flu-like S/S

§  Fever

§  Headache

§  Nausea

§  Anorexia

§  Fatigue

o   RUQ tenderness

how long does chronic hep last?

6 months or more

with what condition does chronic hep occur?

with HCV and HBV

\-can be asymptomatic

what eventually occurs with chronic hep C?

Silently causes formation of scar tissue/fibrosis

·      Leads to liver failure and cirrhosis

As hepatitis progresses what will the s/s be?

§  Jaundice

§  Inflammation

§  Color changes in stool (pale)

§  Color changes in urine (dark)

how do you diagnose hep.A?

§  Positive hepatitis A antibodies

§  Hepatitis A IgM during the acute phase

·      IgM = immediate infection, happening “right now”

§  Hepatitis A IgG

·      IgG = past infection, it is gone

how do you diagnose hep.B?

§  Positive Hepatitis B surface antigen – HbgAg

·      This is an active infection

§  Will be positive if the pt is vaccinated

how do you diagnose hep.C?

§  Positive Hepatitis C virus antibodies = infection

§  Anti-HCV

§  Enzyme immunoassay (EIA)

if a pt has hepatitis (inflammation of the liver) what can u expect?

§  __Elevated liver enzymes – AST, ALT__

§  __Elevated Alkaline phosphate__

§  __Elevated Total bilirubin__

what lab will let you know if hepatitis is d/t alcohol, statin, or tylenol?

an elevated AST

Most pt’s with hepatitis will not seek care for flu-like symptoms until they start to experience what?

§  RUQ TENDERNESS

§  Distaste for cigarettes or food

§  Bilirubin issues

·      Jaundice – d/t bili build up on skin

·      Dark urine – d/t bili being excreted in large quantities thru urine

·      Clay colored stool – d/t bili not being excreted thru stool d/t decreased liver metabolism

·      Pruritus – intense generalized itching d/t accumulation of bile salts in the skin

What are the nursing intervention for acute hepatitis?

can be managed at home

high calorie diet

small freq. meals

rest

avoid drugs detoxed by liver (tylenol or mycins)

avoid sexual intercourse until tests are negative

Notify contacts

Administer vaccine (After recovery (HAV))

What are the nursing intervention for chronic HBV?

§  Administer medications

·      Antivirals – to reduce the viral load and slow the rate of liver fibrosis

What are the nursing intervention for chronic HCV?

§  Administer medications

·      Direct acting antivirals (DAA)

o   Eradicates the virus allowing pt to be cured

o   Peginterferon alfa-2a aka “pegasys”

·      Ribavirin (antiviral)