Week 8: Infectious Hepatitis and Metabolic-Associated Steatohepatitis (MASH)

Hepatitis

Inflammation of the liver

-acute: resolves in 6 months

-chronic: lasts for longer than 6 months

pathophys of MASLD and MASH

MASLD- excess fat in liver not caused by alcohol

MASH-excess fat in liver cells associated with inflammation and scarring

S/S of MASLD and MASH

often no symptoms

general hepatitis symptoms

long term= jaundice

dark urine

itching

Labs/diagnosis of MASLD and MASH

hepatosplenomegaly in 50% of patients

jaundice

increased liver enzymes

hepatic steatosis on ultrasound

treatment for MASLD and MASH

weight loss

NO ALCOHOL

manage DM

decrease cholesterol and triglycerides

weight management meds

hep A and B vaccine

vit E supplement

trends of hepatitis viruses

hep a- decreased due to handwashing

hep b- stable

hep c- increased due to opioid epidemic

transmission mode for viral hepatitis

hep a- fecal-oral

hep b- blood/bodily fluids

hep c- blood-blood

viral hepatitis infectious periods

hep a- two weeks before onset of symptoms

hep B and C- 1-2 weeks before onset of symptoms (chronic= for life)

S/S of acute hep A

most adults have symptoms like:

fatigue

fever

RUQ pain

jaundice

dark urine

S/s of Hep C:

-usually asymptomatic

-fatigue

-fever (low grade)

-malaise, muscle and joint aches

-loss of appetite

-nausea and vomiting

-RUQ abdominal pain

S/s of Hep B:

-50% are asymptotic

-fatigue

-fever (low grade)

-malaise, muscle and joint aches

-loss of appetite

-nausea and vomiting

-RUQ abdominal pain

S/s of long-term hepatitis:

-weight loss

-jaundice

-dark urine

-pale or clay colored stool

-abdominal distention

-generalized itching

likelihood of chronic infection for viral hep

hep a- NOT APPLICABLE

hep b- varies with age- 90% of infants get chronic, 25-50% for children

hep c- 50% of cases

long term prognosis viral hep

hep a- most recover without liver damage

hep b- most recover without liver damage, 15-20% with chronic HBV develop chronic liver disease, cirrhosis, failure etc

hep c- 5-10% develop cirrhosis, 1-5% die from liver cancer

treatment for viral hep 

hep a- no specific treatment= supportive care at home (admin vaccine to unvaccinated person older than 1 yr)

hep b- mainly supportive, HBV vaccine and HBIG admin immediately after exposure

Chronic- low risk people= monitor viral load and liver enzymes

high risk= antiviral medication

hep c- DAA during acute infection

exposure prevention for viral hep

hep a- get vaccine, wash hands, avoid contaminated food/water, contact precautions

hep b- get vaccine, do not share needles/razors/toothbrushes, use condoms

hep c- do not share needles/razors/toothbrushes, use condoms,use gloves

vaccine recommendations/schedules for hepatitis

hep a- routine for all children 12-23 months, 2nd dose given 6-12 months after first

hep b-  recommended for all people, 3 doses, second dose given 1 month after first, third dose given 5 months after second

hep c- no vaccine available 

Stages of Jaundice:

-pre hepatic

-intra hepatic

-post hepatic

Unconjugated (indirect) bilirubin reference range:

0.1-1.0 mg/dL

Conjugated (direct) bilirubin reference range:

0.1-0.3 mg/dL

Equation to calculate unconjugated bilirubin:

TOTAL- conjugated = unconjugated

Urobilinogen

normally a tiny amount of bile is present in the urine

Bilirubinuria

-normally no bilirubin

-elevated levels of urine found WHEN BILE DUCTS BLOCKED

Nursing considerations for Hep A:

-no specific treatment

-POST exposure: get the vaccine, immune globulin within 2 weeks

Nursing considerations for Hep B:

-POST: get vaccine and Hep B immune globulin

liver metabolic functions

carb metabolism

hormone metabolism

protein metablism

metabolizes ammonia into urea

fat metabolism

SVR

hep c virus is not detected in blood at 12 weeks after completing treatment

cure for 99%