Hepatitis A

hepaDefinition:

Hepatitis A is a liver disease caused by the hepatitis A virus. This is an inflammation of the liver that is not really very severe and runs an acute course. This generally starts within two to six weeks after contact with the virus, and lasts no longer than two months. It is known as infectious hepatitis because it spreads relatively easy from those infected to close contact.

Incubation Period:

The incubation period for hepatitis A ranges from 15-60 days or three to five weeks; with a mean incubation period of 30 days.

Period of Communicability:

The infected patient is capable of transmitting the organism a week before and a week after the appearance of symptoms.

Mode of Transmission:

  1. hepatitis carrierHepatitis A virus is transmitted by ingestion of contaminated drinking water or ice, uncooked fruits and vegetable, and fruits and vegetables grown in or washed with contaminated water.
  2. It is also transmitted through fecal-oral pathway.
  3. The virus is transmitted also by infected food handlers.

Groups who are at risk for Hepatitis A Virus:

  1. Children in Day Care Centers can transmit the infection through diapers and toys.
  2. Troops living under crowded conditions at military camps or in the field are at great risk.
  3. Homosexual men are increasingly at risk of HAV infection from oral-anal sexual contact.
  4. People who live in areas with breakdown sanitary conditions, such as after flood and other natural disaster.

Clinical Manifestations:

  1. Flu-like illness with chills and high fever
  2. Diarrhea, fatigue and abdominal pain
  3. Loss of appetite
  4. Nausea, diarrhea and fever
  5. Jaundice and dark-colored urine.
  6. The infection in young children is often mild and asymptomatic.

Complications:

  1. Progressive encephalopathy characterized by drowsiness and cerebral edema
  2. GIT bleeding progressing to stupor and later coma. Bleeding is not responsive to parenteral Vitamin K administration.
  3. Clonus and hyperflexia are later replaced by loss of deep tendon reflexes.
  4. Edema and ascitis
  5. Aplastic anemia.
  6. In late course of the disease, loss of corneal and papillary reflexes, elevated arterial blood, respiratory failure, to cerebrovascular collapse may be present.

Diagnostic Procedure:

  1. HAV and HBV – complement fixation rate
  2. Liver function test – to determine the presence and extent of liver damage and to check the progress of the liver
  3. Bile examination in stool and urine
  4. SGOT – serum glutamix oxaloacetic transaminase
  5. SGPT – serum glutamic pyruvic transaminase
  6. ALT – serum alanine transaminase
  7. IgM level

Treatment Modalities:

  1. There is no specific treatment, although bed rest is essential.
  2. Diet must be high in carbohydrate, low in fat, and low in protein.
  3. Patient must take vitamin supplement especially the B complex group.
  4. Intravenous therapy is occasionally necessary.
  5. Isoprinosine (methisoprenol) may enhance the cell-mediated immunity of the T-lymphocytes.
  6. Alkalies, belladonna and anti-emetics should be administered to control dyspepsia and malaise.

Nursing Management:

  1. The patient must be isolated (enteric isolation).
  2. Patient should be encouraged to rest during acute or symptomatic phase.
  3. Improve nutritional status.
  4. Utilize appropriate measures to minimize spread of the disease.
  5. Observe the patient for melena and check stool for the presence of blood.
  6. Provide optimum skin and oral care.
  7. Increase in ability to carry out activities.
    1. Encourage the patient to limit activity when fatigued.
    2. Assist the client in planning periods of rest and activity.
    3. Encouraged gradual resumption of activities and mild exercise during recovery.

Prevention Control:

  1. Hands should be washed thoroughly every after use of toilet.
  2. Travelers should avoid water and ice if unsure of their purity.
  3. Food handlers should carefully be screened.
  4. Safe preparation and serving of food must be practiced.
  5. The public should be educated on the mode of transmission of the disease.

Hepatitis A Vaccines:

  • vaccinesThe vaccine protects against the virus in more than 95% of cases for 10 years.
  • It contains inactivated Hepatitis A virus providing active immunity against a future infection.
  • The vaccine was first phased in 1996 for children in high-risk areas, and in 1999 it was spread to areas with elevating levels of infection.
  • The vaccine is given in two doses in the muscle of the upper arm. The first dose provides protection two to four weeks after initial vaccination; the second booster dose, given six to twelve months later, provides protection for up to twenty years.

Nursing Care Plan – Hepatitis A
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