hepatitis

(hep″ă-tīt′ĭs)

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[hepato- + -itis]
Inflammation of the liver, usually caused by exposure to an infectious agent (such as a hepatitis virus), a toxin (such as alcohol), or a drug (such as acetaminophen). The illness may be mild or life-threatening, chronic or acute. Chronic cases may be detected only by the discovery of elevated liver enzymes in the blood. Acute cases are marked by jaundice, hepatic enlargement, occasional bleeding, altered mental status, and multiple organ system failure. Usually, a history of any type of hepatitis (esp. after age 10), is a contraindication to being a blood donor.

PATHOLOGY
Damage to liver cells is caused by direct injury from the causative agent or indirectly as a result of inflammatory or autoimmune responses. During acute inflammation, the swollen hepatocytes are less able to detoxify drugs; to produce clotting factors, cholesterol, plasma proteins, bile, and glycogen; to store fat-soluble vitamins; or to perform other functions. All hepatitis viruses may cause fulminant hepatitis, but hepatitis B and D are the most common causes. Drug overdoses, ingestion of toxins, and shock are also responsible for rapid liver deterioration.

PATIENT CARE
Patients are not generally hospitalized unless they experience significant liver damage or complications; the more severely affected patients need supportive medical and psychological care. Patients at home should be instructed about the nature and course of the illness, its care and treatment, and signs and symptoms of complications. When hepatitis is food-borne, thorough handwashing, safe food handling, and thorough cleaning of dishes and silverware are necessary to prevent transmission to other members of the household. The patient should avoid intimate contact with others until antigen and antibody levels are reduced. The patient is advised to schedule frequent rest periods and to rest between major activities. Diversionary activities should be included to help reduce anxiety. Good nutrition is encouraged (small, frequent, high-calorie, low-protein, nutrient-dense meals and fluids to 4 qt (4 L)/day). Fluid intake and output, and weight, color, consistency, and frequency of stools should be recorded. The hospitalized patient is assessed for complications (hepatic coma, pneumonia, vascular problems, and pressure ulcers) and is advised to avoid alcohol during the period of acute illness and for at least 6 months after recovery. Depression may occur because of the patient’s concerns about the illness, but the depression may also be linked to changes in body chemistry or adverse drug reactions. Hepatitis is the primary reason for liver transplants, and the concerns of potential need and treatment should be explained to the patient. Emotional support and reassurance should be offered because there may be considerable interference with the patient's habits and lifestyle.
Standard Precautions Appendix
; SEE: hepatitis A; SEE: autoimmune hepatitis; SEE: hepatitis E; SEE: fulminant hepatitis
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