Inflammation of the liver parenchyma can be caused by three main factors: immunologic damage, infections (viruses, bacteria, fungi, protozoa), and toxicity (alcohol, drugs, poisons, chemicals). The common form of hepatitis is viral, infectious, and widespread. Chronic inflammation of the liver results in degeneration and necrosis, which leads to the proliferation and enlargement of the phagocytic and pinocytic kupffer cells. Inflammation also affects the periportal areas, which interrupt bile flow.
Viral Hepatitis
Hepatitis A
- Transmission: RNA Virus via the fecal-oral route.
- Risks: poor hygiene, food contamination, shellfish consumption. Flies may carry Hep. A.
- Incubation Period: 15 to 45 days.
Hepatitis B
- Transmission: DNA Virus via all body fluids.
- Risks: sharing needles among IV drug abusers, sexual contact, healthcare workers exposed to blood.
- Incubation Period: 1 to 6 months.
- Develops into chronic hepatitis in 10% of adult and 90% of neonatal cases.
- Accounts for 50% of fulminant hepatitis.
Hepatitis C
- Transmission: RNA Virus via blood products.
- Risks: sharing needles among IV drug abusers.
- Incubation Period: 2 to 6 months.
- Develops into chronic hepatitis in 70% to 80% of cases.
- It used to be the most common form (90%) of transfusion hepatitis before 1990.
Hepatitis D
- Transmission: RNA Virus simultaneous with or superimposed over a hepatitis B infection. It resides in blood products. It cannot be contracted without hepatitis B.
- Risks: sharing needles among IV drug abusers, hemophiliacs.
- Hep. D produces the highest risk among acute viral hepatitis for fulminant disease. If it is obtained via a superimposed infection (super-infection), the risk if even greater.
Hepatitis E
- Transmission: fecal-oral route.
- No chronic form
- Fulminant disease is mainly observed in pregnant patients.
Assessment Findings
Preicteric Stage (Prodromal Phase)
This lasts for approximately 1 week.
- Anorexia is the major manifestation.
- N&V, Fatigue, Constipation or diarrhea, Weight Loss
- RUQ Discomfort, Hepatomegaly, Splenomegaly, Lymphadenopathy.
Icteric Stage
- Fatigue, weight-loss, light-colored stools (decreased bilirubin in the GIT), dark urine (increased bilirubin in urine)
- Hepatomegaly is now tender.
- Jaundice, Pruritus (subcutaneous bile salt deposition)
Posticteric Stage
- Fatigue, an increased sense of well-being, and retrogressive hepatomegaly.
Collaborative Management
- Relieve fatigue with promotion of rest.
- Advise client to use soft toothbrushes or swabs.
- Monitory I&O and weight
- Vitamin K as ordered (decreased clotting ability due to liver impairment)
- Relaxing baths, backrubs, fresh linens, and a quiet, dark environment.
- Relieve pruritus
- Cool, light, non-restrictive clothing
- Soft, dry, clean bedding
- Warm baths
- Emollient creams and lotions for dry skin
- Cool environment
- Antihistamines as ordered
- Diversion with activities
Dietary Management
- Well-balanced diet and fluids; encourage fruit juices and non-carbonated beverages. 3L/d may be given for patients with fever and vomiting.
- Fats may need to be restricted (decreased bile in the GIT for fat emulsification)
- Alcholic Beverages should be avoided (toxic to the liver)