Hepatitis D – Delta Hepatitis

Hepatitis D is a defective RNA that appears to replicate only with the hepatitis B virus. It requires HbsAg to replicate. It occurs along with Hepatitis B or may superinfect a chronic HBV carrier. It cannot outlast a Hepatitis B infection. It may be acute or chronic. Its mode of transmission and incubation period are the same as that of HBV.Its occurrence in the United States is primarily among IV drug users and among recipients of multiple blood transfusions. It causes about 50% of fulminant hepatitis, which has a high mortality.

Clinical Manifestations:

• Similar to Hepatitis B but more severe and chronic active hepatitis and cirrhosis

• With superinfection of chronic HBV carriers, it causes sudden worsening of condition and rapid progression of cirrhosis.

Diagnostic evaluation:

  1. Elevated serum transferase levels – ALT, AST
  2. Anti-delta antibodies in the presence of HBsAg or the detection of IgM in acute disease and IgG in chronic disease.

Prevention:

1. Always screen blood and blood products for blood-borne diseases.

2. Always practice safe sex.

3. Never re-use needles for injections. Always open a new sterile syringe and discard properly after use.

4.Wash hand thoroughly right after direct contact with body fluids of patients with Hepatitis D.

5. Never use the personal belongings of persons with Hepatitis D, such as toothbrush, eating utensils, razor, etc.

Medical Management:

  1. Targeting the causative agent of Hepatitis B may also kill the causative agent of Hepatitis D.
  2. Interferon is under investigation as a specific treatment for Hepatitis D.
  3. Acyclovir, ribavirin, lamivudine and synthetic analogues of thymosin have proved ineffective.

Nursing Management:

  1. Inform the patient and family members about the nature of the disease if the patient is taken care at home.
  2. Assist is paracentesis if indicated.
  3. Patients with cirrhosis could be in deep pain and discomfort, use of analgesics should be administered with great caution since it can worsen the liver damage.
  4. Diversionary therapy and non-pharmacological approach should be applied in managing pain.
  5. Ongoing monitoring of vital signs, abdominal girth and reminding for the routine check-up must be emphasized for effective management.Photo credits: www.google.com.ph

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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