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Hepatitis and Biliary (Hepatitis B (Management: Good hygienic practices…

- - - - Pathophysiology:
        Presence of Risk Factors (contaminated food, water, etc.)> Cellular immune response > Hepatocyte injury > If no complications, hepatocytes regenerate and resume > normal function and appearance
        
        DIAGNOSTIC TEST
        Hepatitis A virus test: looks for presence of
        • antibodies (anti-HAV)
        • Immunoglobulin (IgM) can be found as early as two weeks after being infected.
        • immunoglobulin G (IgG) [identifies previous infection]
        • Hep A antigen found in stool 7 -10 days before illness and for 2-3 weeks after symptoms appear.
      - Incidence
        Cases have declined by 92% since vaccinations were recommended for children (at 1 year of age) and people at risk. In 2013, hepatitis A virus incidence was 3473 cases in the United States. Most common in adults than in children. More prevalent in with overcrowding and poor sanitation.
- - - - :warning:Testing For HCV
        :warning: Testing for the HCV antibody, HCV RNA testing, viral genotype testing (for drug therapy) and biopsy.
        :warning: HCV has 6 genotypes and more than 50 subtypes, It is important to do genotyping to find out how the patient will respond to drug therapy.
        
        Treatment for HCV and Nursing Considerations
        :red_flag:If acute: pegylated interferon (first 12-24 weeks)
        :red_flag:For chronic, drug therapy is directed at eradicating the virus and preventing further complications. It is individualized and depends on the genotype.
        :red_flag:Some medications used are: pegylated interferon given with ribavirin. HCV protease inhibitors are also given such as telaprevir or boceprevir.
        :<3: Nursing consideration:
        :<3: There is no vaccine for HCV. As a nurse, you must educate your patients on preventative measures.
        :<3: Ensure your patient receives adequate nutrition and rest. Educate your patient on their drug treatment (interferon is administered by the patient or caregiver).
- - - - Incidence: Occurs mostly in developing countries such as Asia, Africa, and Mexico
        
        Diagnostics: HEV RNA quantitaion which indicates an on going replication
        
        Assessment: Assess history of drinking water, uncooked foods, and contact with jaundiced people
        
        Clinical Manifestations: Jaundice, loss of appetite, nausea, anorexia, fatigue, weight loss, fever, abdominal pain, dark urine, clay-colored stool
        
        Management: Rest and assist liver regenerating. Adequate nutrition, patient should avoid alcohol, comfort measures for pruritus, small meals, oral care, antiemetics and limited activity.
        
        Nursing Diagnosis: Imbalanced nutrition related to nausea and anorexia. Goal: Initiate behaviors and life style changes to regain and maintain weight. Nursing Interventions: 1. Monitor calories and give small meals. Large meals may be hard for patient to manage. 2. Provide mouth care. Enhances appetite by eliminating unpleasant tastes. 3. Recommend eating in upright position. Reduces sensation of abdominal fullness. 4. Give fruits, hard candy, and carbonated drinks. Its extra calories the patient may be able to tolerate. 5. Monitor glucose levels. Hypo- or hyperglycemia may develop which would require changes in the diet.
- - - - Etiology/ Incidence
        
        •HDV is common in the Mediterranean and Middle Eastern areas
        •Hepatitis D occurs only among people who are infected with the Hepatitis B virus.
        •Transmission requires contact with infectious blood.
        •Simultaneous co-infection with HBV and HDV occurs in 5% of those with HBV.
        •Approximately 15-20 million people are co-infected with HDV and HBV worldwide.
        
        At-risk populations:
        •Drug users
        •Clients receiving hemodialysis
        •Clients receiving frequent blood transfusions
        
        Pathophysiology
        
        Presence of Risk factors or causative factors (infections, toxins, viruses)
        ↓
        Cytotoxic cytokines and natural killer cells cause lysis of infected liver cells
        ↓
        Inflammation of liver
        ↓
        Cholestasis (the flow of bile from the liver stops or slows)
        ↓
        Chronic Inflammation
        ↓
        Fibrous of liver
        ↓
        Cirrhosis
        ↓
        Signs and Symptoms
        
        CLINICAL MANIFESTATIONS
        
        The symptoms of hepatitis D are like those of hepatitis B except that patients are more likely to develop fulminant hepatitis and progress to chronic active hepatitis and cirrhosis in about 5% of patients
        Some signs/symptoms include the following:
        •Jaundice
        •Dark urine
        •Abdominal pain
        •Nausea with vomiting
        •Confusion, bruising, and bleeding (rare)
        •Pruritus
        
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- - - - Cholecystitis: inflammation of the gallbladder
        
        Etiology: Cholelithiasis- cause is unknown, infection, disturbances in the metabolism of cholesterol. Cholecystitis- obstruction caused by gallstones or biliary sludge.
        
        Pathophysiology: Presence of risk factors > imbalance of cholesterol, bile salts, and calcium > substances precipitate > formation of gallstones > decrease in bile flow > stasis of bile > obstruction of cystic or bile duct > Cholecystitis
        
        Assessment:
        Past health history- obesity, multiparty, infection, cancer, extensive fasting, pregnancy.
        Medications- estrogen or oral controceptives
        Surgery- abdominal surgery
        Weight loss, anorexia; indigestion, fat intolerance, nausea and vomiting, dyspepsia; chills. Clay-colored stools, steatorrhea, flatulence; dark urine, moderate to severe pain in RUQ that may radiate to back or scapula; pruritus. Fever, restlessness, jaundice, icteric sclera, diaphoresis, tachypnea, splinting during respirations, tachycardia, palpable gallbladder, abdominal gaurding/distention
        
        Diagnostics: History and physical examination, ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), Percutaneous transhepatic cholangiography, liver function studies, WBC, serum bilirubin
        
        Management: IV fluid, NPO with NG tube, procession to low-fat diet, antiemetics, analgesics, Fat-soluble vitamins (A,D,E,K), Anticholinergics (antispasmodics), antibiotics (for secondary infection), transhepatic biliary catheter, ERCP with sphincterotomy (papillotomy), Extracorporeal shock wave lithrotripsy.
        Surgical therapy: laproscopic cholecystectomy, incisional cholecystectomy
        
        1 more item...
        
        Incidence: Approximately 8% to 10% of American adults have cholelithiasis. Cholelithiasis is higher in women, especially multiparous women, and persons over 40 years of age. More common in Asian Americans and African americans than in whites. Incidence is especially high in the native american population, particularily in the Navajo and Prima tribes.