The liver and spleen are often moderately enlarged for a few days after onset; other than jaundice, there are few other physical signs. Hepatitis A antigen may be found in the stool 7 to 10 days before illness and for 2 to 3 weeks after symptoms appear. HAV antibodies are detectable in the serum, but usually not until symptoms appear. Analysis of subclasses of immunoglobulins can help determine whether the antibody represents acute or past infection.

Bed rest during the acute stage and a diet that is both acceptable to the patient and nutritious are part of the treatment and nursing care. During the period of anorexia, the patient should receive frequent small feedings, supplemented if necessary by IV fluids with glucose. Because the patient often has an aversion to food, gentle persistence and creativity may be required to stimulate appetite. Optimal food and fluid levels are necessary to counteract weight loss and to speed recovery. Even before the icteric phase, however, many patients recover their appetites.The patient’s sense of well-being and laboratory test results are generally appropriate guides to bed rest and restriction of physical activity. Gradual but progressive ambulation seems to hasten recovery, provided the patient rests after activity and does not participate in activities to the point of fatigue

The nurse assists the patient and family in coping with the temporary disability and fatigue that are common in hepatitis. The patient and family need specific guidelines about diet, rest, follow-up blood work, and the importance of avoiding alcohol, as well as sanitation and hygiene measures (particularly handwashing) to prevent spread of the disease to other family members. Specific teaching to patients and families about reducing the risk of contracting hepatitis A includes good personal hygiene, stressing careful handwashing (after bowel movements and before eating) and environmental sanitation(safe food and water supply, effective sewage disposal).

Many patients are anicteric (without jaundice) and symptomless.

In symptomatic patients:
-low grade fever
-anorexia
-jaundice
-dark urine
-indigestion
-aversion to strong odors

The goals of treatment are to minimize infectivity and liver inflammation and decrease symptoms.

Of all the agents that have been used to treat chronic type B viral hepatitis, alpha-interferon as the single modality of therapy that offers the most promise.

Two antiviral agents, lamivudine (Epivir) and adefovir(Hepsera), oral nucleoside analogs, have been approved for use in chronic hepatitis B in the United States. Studies have revealed improved seroconversion rates, loss of detectable virus, improved liver function, and reduced progression to cirrhosis with lamivudine. It can be used for patients with decompensated cirrhosis who are awaiting liver transplantation. Adefovir may be effective in people who are resistant to lamivudine.

Bed rest may be recommended, regardless of other treatment, until the symptoms of hepatitis have subsided. Activities are restricted until the hepatic enlargement and levels of serum bilirubin and liver enzymes have decreased.

Adequate nutrition should be maintained. Proteins are restricted if symptoms indicate that the liver’s ability to metabolize protein byproducts is impaired. Measures to control the dyspeptic symptoms and general malaise include the use of antacids and antiemetics, but all medications should be avoided if vomiting occurs.

Hepatitis A is caused by an RNA virus of the Enterovirus family. This form of hepatitis is transmitted primarily through the fecal-oral route, by the ingestion of infected foods or liquids. It is more prevalent in countries with overcrowding and poor sanitation. The virus has been found in the stool of infected patients before the onset of symptoms and during the first few days of illness.

The incubation period is estimated to be between 2 to 6 weeks. The illness may be prolonged, lasting 4 to 8 weeks.It usually lasts longer and is more severe in those older than 40 years of age. Most patients recover from hepatitis A; it rarely progresses to acute liver necrosis or fulminant hepatitis resulting in cirrhosis of the liver or death.

Follow-up visits by a home care nurse may be needed to assess the patient’s progress and answer family members’ questions about disease transmission.

During a home visit, the nurse assesses the patient’s physical and psychological status and confirms that the patient and family understand the importance of adequate rest and nutrition. The nurse also reinforces previous instructions. Because of the risk of transmission through sexual intercourse, strategies to prevent exchange of body fluids are recommended, such as abstinence or the use of condoms. The nurse emphasizes the importance of keeping follow-up appointments and participating in other health promotion activities and recommended health screenings.

It is believed that hepatitis E virus (HEV) is transmitted by the fecal-oral route, principally through contaminated water in areas with poor sanitation.

The incubation period is variable, estimated to range between 15 and 65 days.

In general, hepatitis E resembles hepatitis A. It has a self-limited course with an abrupt onset.

Jaundice is almost always present.

Chronic forms do not develop.

Avoiding contact with the virus through good hygiene, including handwashing, is the major method of prevention of hepatitis E.

The effectiveness of immune globulin in protecting against hepatitis E virus is uncertain.