Hepatitis A, B, C, D, E

With Hepatitis A, the patient can be contagious

2 weeks BEFORE the signs and symptoms appear and 1-3 weeks from when the symptoms appeared.

Hepatitis D (HDV)

A bloodborne virus, it can only exist in combination with the hepatitis B virus. HBV vaccine will offer protection against HDV.

Acute and chronic infections can occur

A high percentage of Hepatitis C becomes chronic, which increases the risk for liver disease. Chronic infections can lead to major complications like: cirrhosis, liver failure, and liver cancer

How you get it (transmitted)?

Blood and body fluids.... spread via percutaneous (via the skin through a puncture) or in body fluids with mucosal route Most common transmission route intravenous drugs.Other ways but not as common: sexual contact, if received blood or blood products before 1992, sharp injuries (needle or instruments), long-term dialysis increases risk of exposure too

Hepatitis A

Most common is fecal-oral: a person is most likely to get the virus from consuming contaminated food or water. Acute type of infection only: no long term complications likely because the virus is in the body for a short time and killed by the body

signs and symptoms

Same as above if present

Hepatitis E (HEV)

Spread by fecal-oral transmission Similar to hepatitis A Endemic in areas with poor sanitation

What is hepatitis?

liver inflammation

treatment

none

The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver.* A. hepatic artery B. hepatic portal vein C. mesenteric artery D. hepatic iliac vein

The answer is B. The liver receives blood from two sources. The hepatic portal vein is responsible for pumping blood rich in nutrients to the liver.

treatment

antiviral medications or interferon (Peginterferon alfa-2a (Pegasys)

How you get it (transmission)?

Fecal-oral: from consuming contaminated water or food (can also be transmitted in undercooked meat like pork or wild game) Acute infection only: can cause major complications in pregnant women in the 3rd trimester Tends to be more prevalent in developing countries and in people who globally travel

diagnosed

HBsAg (Hepatitis B surface antigen): show infectious (educate: avoid sexual intercourse and intimacy like kissing until it is negative) Anti-HBs (Hepatitis b surface antibody): means patient is recovered (had a previous infection) and immune (example: effective Hepatitis B vaccine)

5 types of viral hepatitis

Hep A, B, C, D, E

Quick highlighted review of the above comparison:

Hepatitis A and E are very similar: Both transmitted fecal-oralBoth ONLY cause acute infections Both treatment: supportive and rest hepatitis A has a vaccine and immune globulin. Hepatitis E does NOT have a vaccine in the US or post-exposure immune globulin Hepatitis B, C, D are similar:All transmitted via blood/body fluids cause either acute and chronic infections treatment can include antivirals and interferon Only Hepatitis B has a vaccine and post-exposure immune globulin.

Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection?*A. A 45-year-old male with diabetes.B. A 26-year-old female in the 3rd trimester of pregnancy.C. A 12-year-old female with a ventricle septal defect.D. A 63-year-old male with cardiovascular disease.

The answer is B. Patients who are in the 3rd trimester of pregnancy are at a HIGH risk of developing a complication related to a Hepatitis E infection.

How you get it (transmitted)?

Only infects a person when they have Hepatitis B. Blood and body fluids.... spread via percutaneous (via the skin through a puncture) or in body fluids with mucosal route...same as Hepatitis B. Not as common in the US compared to Southern and Eastern Europe and the Mediterranean and the Middle East. Acute and chronic infections can present.

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear.*

TRUE.

How is Hepatitis E transmitted?* A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

The answer is A.

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient?*A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative.B. The patient is now recovered from a previous Hepatitis B infection and is now immune.C. The patient is not a candidate from antiviral or interferon medications.D. The patient is less likely to develop a chronic infection.

The answer is A. A positive HBsAg (hepatitis B surface antigen) indicates an active Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and other forms of intimacy until their HBsAg is negative.

A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis?* A. Icteric B. Posticteric C. Preicteric D. Convalescent

The answer is A. The Preicteric (prodromal) Phase: flulike symptoms...joint pain, fatigue, nausea vomiting, abdominal pain change in taste, liver enzymes and bilirubin increasing....Icteric Phase: decrease in the flu-like symptoms but will have jaundice and dark urine (buildup of bilirubin) yellowing of skin and white part of the eyeball, clay-colored stool (bilirubin not going to stool to give it's normal brown color) enlarged liver and pain in this area....Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change?* A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

The answer is A. When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective.* A. 2 weeks B. 24 hours C. 1 month D. 7 days

The answer is B. HBIg should be given 24 hours after exposure to maximum effectiveness of temporary immunity against Hepatitis B. It would be given within 12 hours after birth to an infant born to a mother who has Hepatitis B.

Signs & Symptoms

asymptomatic (some patient may be without symptoms) Jaundice GI symptoms: nausea, vomiting, stomach pain, loss of appetite Fever Very tired Dark urine (bilirubin) Clay-colored stool (no bilirubin in stool) Arthralgia (joint pain)

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as?*A. The patient has an active infection of Hepatitis A.B. The patient has recovered from a previous Hepatitis A infection and is now immune to it.C. The patient is in the preicetric phase of viral Hepatitis.D. The patient is in the icteric phase of viral Hepatitis.

The answer is B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis?* A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

The answer is C. Hand hygiene can help prevent all types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Remember Hepatitis A and E are spread only via fecal-oral routes.

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful?* A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

The answer is C. Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 15-45 mcg/dL).

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is?* A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

The answer is C. There is no current treatment for Hepatitis A but supportive care and rest. Treatments for the other types of Hepatitis such as B, C, and D include antiviral or interferon (mainly the chronic cases) along with rest.

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route?* A. Oral B. Intramuscular C. Subcutaneous D. Intravenous

The answer is C. This medication is administered subq.

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B?* A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

The answer is D. A positive anti-HBs (Hepatitis B surface antibody) indicates either a past infection of Hepatitis B that is now cleared and the patient is immune, OR that the vaccine has been successful at providing immunity. A positive HBsAg (Hepatitis B surface antigen) indicates an active infection.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is?* A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

The answer is D. Hepatitis A is most commonly transmitted via the fecal-oral route.

What is the MOST common transmission route of Hepatitis C?* A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

The answer is D. IV drug use is the MOST common transmission route of Hepatitis C.

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient?* A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

The answer is D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because infection is possible. The patient should not wait until signs and symptoms appear because the patient can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine would not prevent Hepatitis A from this exposure, but from possible future exposures because it takes the vaccine 30 days to start working. The best answer is option D. The patient would need to receive immune globulin to provide temporary immunity within 2 weeks of exposure.

Select all the types of viral Hepatitis that have preventive vaccines available in the United States?* A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

The answers are A and B. Currently there is only a vaccine for Hepatitis A and B in the U.S.

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply:* A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

The answers are A and B. These are true statements about Hepatitis D. Prevention for Hepatitis D includes handwashing and the Hepatitis B vaccine (since it occurs only with the Hepatitis B virus). It is transmitted via blood.

Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply:* A. The liver has 3 lobes and 8 segments. B. The liver produces bile which is released into the small intestine to help digest fats. C. The liver turns urea, a by-product of protein breakdown, into ammonia. D. The liver plays an important role in the coagulation process.

The answers are A and C. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver's anatomy and physiology.

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply:* A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

The answers are A and E. Only Hepatitis A and E cause ACUTE infections...not chronic. Hepatitis B, C, and D can cause both acute and chronic infections.

Select all the signs and symptoms associated with Hepatitis?* A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

The answers are A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply:* A. Increased ALT and AST levels along with an increased bilirubin level B. Decreased liver enzymes and bilirubin level C. Flu-like symptoms D. Resolved jaundice and dark urine

The answers are B and D. Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to norma

Select all the ways a person can become infected with Hepatitis B:* A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

The answers are B, C, E, and F. Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply:* A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

The answers are B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply:* A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

The answers are B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply:* A. Water B. Food C. Semen D. Blood

The answers are C and D. The most common source for transmission of Hepatitis A is water and food.

signs and symptoms

asymptomatic (some patient may be without symptoms) Jaundice GI symptoms: nausea, vomiting, stomach pain, loss of appetite Fever Very tired Dark urine (bilirubin) Clay-colored stool (no bilirubin in stool) Arthralgia (joint pain)

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply:* A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

The answers are C and D. The patient should NOT take acetaminophen (Tylenol) due to its effective on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

treatment

acute: none just supportive treatment chronic: antiviral medications or interferonPeginterferon alfa-2a (Pegasys): given subcutaneous

diagnosed

anti-HAV (antibodies of the hepatitis A virus) presence with IgM and IgG in the blood anti-HAV igM = active infection (in icteric phase) anti-HAV IgG = past infection and recovered and has immunity...if received the vaccine it workedHow to remember? IgM (think mean virus is present in the body) and IgG (think the virus is gone)

diagnosed

antibodies to detect HEV

treatment

antiviral medication like direct acting antivirals (DAAs)

How you get it (transmitted)?

blood and other body fluids like semen, salvia, ammonitic or vaginal fluid etc. Most common transmission route is sexual intercourse and intravenous drug use. It can also be spread via the birthing process if mother is Hepatitis B positive. Therefore, it can be spread via the percutaneous (via a puncture in the skin...example: needle) or mucosal routes. Acute and chronic infections can occur. Infants and young children at most risk for chronic infections.Chronic infections can lead to major complications like: cirrhosis, liver failure, and liver cancer

Hepatitis C (HCV)

bloodborne viral disease that affects the liver; transmitted by blood exposure, sharing needles, or from infected mother to infant; rarely transmitted by sexual contact

Diagnosed

presence of anti-HCV (antibodies to HCV) for chronic infection...not for acute infections

Liver inflammation can occur for many reasons

drugs excessive alcohol usage medications viruses (most common and referred to as viral hepatitis): this is where a virus attacks the cells of the liver causing them to malfunction.

Prevention

handwashing, NO vaccine currently or immune globulin for post-exposure, following sharp precautions, strict blood and organ donation screening

Prevention

handwashing, getting the Hepatitis B vaccine, NO vaccine for Hepatitis D or post-exposure immune globulin

Prevention

handwashing, no vaccine being used here in the US at this time, if travelling outside US use bottled water, cook meat thoroughly

Prevention

handwashing, vaccine for all infants (3-4 doses over 6-18 months) and people at risk for Hepatitis B..example: healthcare workers (3 doses over 6 months), following sharp precautions, all pregnant women tested due to transmission at birth, post-exposure Hepatitis B immune globulin within 24 hours of exposure (12 hours after birth) to provide temporary passive immunity.

Hepatitis B

inflammation of the liver caused by the hepatitis B virus (HBV), which is transmitted sexually or by exposure to contaminated blood or body fluids

Treatment:

none rest and supportive treatment

diagnosed

presence of HDAg (hepatitis D antigen) and anti-HDV