Hepatitis is a medical condition characterized by inflammation of the liver.

It can result from various

causes, including viral infections, autoimmune diseases, alcohol consumption, toxins, and certain
medications. The inflammation can be acute, meaning it occurs suddenly and can be resolved within a
short period, or chronic, lasting for many months or even years, potentially leading to serious
complications like cirrhosis, liver failure, or liver cancer.

There are several types of viral hepatitis, identified by letters A through E:

LEARNING OUTLINES

Definition/ Introduction

Classification and types

Mode of transmission

Pathophysiology

Causes

Clinical manifestations

Diagnostic technics

Nutritional management and meal plan

Nursing responsibility

DEFINITION/ INTRODUCTION

According to WHO Hepatitis is defined as an inflammation of the liver that is caused by a variety of
infectious viruses and non-infectious agents, leading to a range of health problems some of which can be
fatal. The liver is a vital organ that is responsible for processing nutrients, filtration and detoxification of
blood and also fighting of various infections. This inflammation of the liver parenchyma seen in Hepatitis
affects the ability of the liver to carry out these functions.

CLASSIFICATION AND TYPES

Viral hepatitis

In this case hepatitis is due to a viral infection and it may be transmitted from person to person. They
include hepatitis A, B, C, D,E etc

Non viral hepatitis

This is an inflammation of the liver that can cause scarring of the liver (Cirrhosis), liver cancer, liver
failure and death.

Types of Viral Hepatitis

Hepatitis A: This is also known as the infectious or short-incubation hepatitis. It is caused by Hepatitis A
virus (HAV) which is an RNA Picona virus. The virus is primarily spread when an uninfected person who
is also unvaccinated ingest food or water that is contaminated with the faeces of an infected person
(fecal-oral route). It is a self-limiting disease i.e. the disease is usually acute and does not progress to a
chronic stage. It is common in tropical and sub-tropical regions and has an incubation period of 30 days.

Hepatitis B: This is also known as serum or long incubation hepatitis. It is due to an infection with
Hepatitis B virus (HBV) which belongs to the DNA Hepadnavirus family. The virus is transmitted through
contact with the blood and body fluids (sweat, saliva, semen, tears and breastmilk) of an infected
person. Its incubation period is about 30-180 days. This disease can progress from the acute to chronic
stage and neonates are at a higher of risk of progressing to the chronic stage.Patients with HIV are also at
risk for co-infection with Hepatitis B this is because these two infection spread via the same means.

Hepatitis C: This type of hepatitis is caused by Hepatitis C virus (HCV), a single stranded RNA virus which
is also a blood borne virus. Can be transmitted through unsafe blood transfusion or sharing of needles. It
has an incubation period between 6-12 weeks.

Hepatitis D (Delta hepatitis): Caused by Hepatitis B virus (HBV), a single stranded RNA virus. Can be
transmitted through a broken skin or mucous membrane via injection, tattooing, and unprotected sexual
intercourse with infected persons. It can also be transmitted through infected blood or blood products.
It’s incubation period ranges from 2 weeks to 6 months.

Hepatitis E: It is due to infection of Hepatitis E virus (HEV) which is a single stranded RNA virus. It is
transmitted via fecal-oral route i.e. ingestion of food or water contaminated with the faecal matter of an
infected person. It has an incubation period of 6weeks. This disease also doesn’t progress to a chronic
stage.

Types of non-viral hepatitis

Toxic hepatitis: Caused by exposure to toxic substances like; chemicals, drugs (prescription and over the
counter) and nutritional supplement.

Alcoholic hepatitis: As a result of too much or excessive alcohol intake which causes the liver to become
inflamed.

Autoimmune hepatitis: This occurs when the immune system attacks the liver and the cause is
idiopathic. This attack leads to inflammation, liver failure, liver scarring and liver cancer.

MODE OF TRANSMISSION

 Having unprotected sex with an infection person

 Through the fecal-oral route for hep A
 Contact with infected bodily fluids, such as blood, semen, and vaginal secretions
 Transfusions of infected blood or blood products and the sharing of razors or toothbrushes with
an infected person.
 Passed from an infected mother to her baby during childbirth.
  Sharing of razors, syringes, toothbrushes with an infected person.
 Needlestick injuries

PATHOPHYSIOLOGY

The virus enters the liver cells (hepatocytes) and uses the cell’s machinery to replicate (HCV is an RNA
virus that replicates in the cytoplasm while HBV is a DNA virus that integrates into the host genome)
inducing apoptosis (programmed cell death).

The body’s Immune system recognizes the viral antigens on the surface of infected liver cells and targets
these cells for destruction which leads to inflammation and injury to the liver tissue, characterized by the
infiltration of immune cells (e.g., T cells, macrophages) into the liver tissue. Over time (the
inflammation), this can lead to fibrosis (scarring of liver tissue), which can progress to cirrhosis (extensive
liver scarring and dysfunction).

Cirrhosis can lead to significant liver dysfunction, affecting the liver’s ability to perform its vital functions,
complications including portal hypertension, ascites, variceal bleeding, hepatic encephalopathy, and an
increased risk of liver cancer (hepatocellular carcinoma) may occur. The liver has a remarkable ability to
regenerate. In cases of acute hepatitis or mild chronic hepatitis, the liver may fully recover if the
underlying cause is removed or resolved. However, in cases of advanced cirrhosis, the damage is often
irreversible.

CAUSES OF HEPATITIS

 Immune cells in the body attacking the liver

 Infections from viruses (such as hepatitis A, hepatitis B, or hepatitis C), bacteria, or parasites
 Liver damage from alcohol or poison
 Medicines, such as an overdose of acetaminophen
 Fatty liver

CLINICAL MANIFESTATIONS

 Pain or bloating in the belly area

 Dark urine and pale or clay-colored stools
 Fatigue
 Low grade fever
 Itching
 Jaundice (yellowing of the skin or eyes)
 Loss of appetite
 Nausea
 Vomiting
 Weight loss

DIAGNOSIS TECHNICS
  Blood Tests: The doctor draws a small amount of blood from a vein in the arm and sends it to a
laboratory for testing. The results of a blood test can confirm the type of viral hepatitis, the
severity of the infection, whether an infection is active or dormant, and whether someone is
currently contagious.
 Radio Immunoassay: It reveals IgM antibodies to the hepatitis virus in the acute phase.
 Elevated White Blood cells
 Elevated Serum Transferase: Aspartate transaminase (AST)Alanine transaminase (ALT)If one has
high levels of AST and ALT, it may mean that you have some type of liver damage.
 Liver Function Test. Liver function tests check the levels of certain enzymes and proteins in your
blood levels that are higher or lower than usual can mean liver problems. The pattern and
degree of elevation of these tests along with the overall clinical picture can provide hints to the
underlying cause of these problems.
 Prolonged Prothrombin Time: when it’s high, it takes longer for the blood to clot (17 seconds, for
example). This usually happens because the liver is not making the right amount of blood
clotting proteins, so the clotting process takes longer. A high PT usually means that there is
serious liver damage or cirrhosis.
 Liver Biopsy: A liver biopsy is a test used to diagnose liver conditions. Tissue samples are
removed from the liver and checked under a microscope for signs of damage or disease.

SAMPLE MEAL PLAN FOR A HEPATITIS PATIENT

DAYS BREAKFAST SNACKS LUNCH DINNER

Day 1 Oatmeal made An apple Boiled Vegetable
with soya milk with plantains soup with
topped with cashew with fish moderate
bananas or nuts stew and size garri
berries and veggie or boiled
sprinkles of salad yam
chia seeds ( spinach,
cherry
tomatoes,
cucumber
s etc )
Day 2 Moi- moi Vegetable Okra soup Local
( with boiled salad with jollof rice
egg and fish in consisting chicken with
it) and pap of and veggies
spinach, moderate and
cucumber, size garri chicken
tomatoes, or lean
berries meat
with
lemon
dressing
 NUTRITIONAL MANAGEMENT

 Adequate protein intake is important for liver repair and immune function. Choose lean sources
of protein such as fish, poultry, eggs, legumes etc
 Eating smaller, more frequent meals can be easier on the liver than consuming large meals.
 Staying hydrated
 Limit Added Sugars and Refined Carbohydrates
 Avoid Alcohol consumption
 Reduce sodium
 Intake to avoid fluid retention and swelling
 Limit fat intake especially those high in saturated fats, opt for healthy fats found in fish, nuts,
seeds, and vegetable oils like olive oil.

NURSING RESPONSIBILITY

 Conduct thorough patient assessments which includes evaluating the patient’s medical history,
symptoms, and any potential exposure risks.
 Regularly monitor vital signs
 Organize for liver function test.
 Educate patients on the disease, prevention and adherence to treatment regimen
 Administer prescribed medications, monitor for side effects.
 Advice on life style modifications like abstaining from alcohol, certain medications and toxins,
and engaging in regular physical activity.
 Connect patients with support groups, counseling services to help them cope with their
condition and improve their quality of life.
 Ensure patients receive appropriate follow-up care

CONCLUSION

In conclusion, we have looked at the types, causes, management and other factors. Hepatitis
encompasses a complex group of liver diseases with significant health implications. Effective prevention,
early detection, and advancements in treatment are key to managing hepatitis and reducing its impact
on public health worldwide.