Hepatitis is a common viral infection in the hospital population, especially with liver failure patients. There are a variety of strains of hepatitis, some acute and some chronic in nature. The most common type that I have seen in the ICU is Hepatitis C with chronic liver disease patients. When patients are in the ICU, their liver failure is generally very advanced requiring more palliative treatment. What causes this destruction of the liver? How do we prevent this from happening?
“Prevention techniques and vaccinations have markedly reduced the current incidence of common viral hepatitis infections; however, there remains a population of about 800,000 to 1.4 million people in the U.S. with chronic HBV, and about 2.9 to 3.7 million with chronic HCV according to the CDC.”
Types of Hepatitis
Hepatitis A
Cause: Eating or drinking something that has the Hepatitis A virus in it. This is often the fecal-oral route of transmission, meaning that a person ingests food or water that has been contaminated by human waste containing the Hepatitis A virus. It is often spread among household members via the passage of oral secretions (kissing) or stool (poor hand hygiene).
Length of Infection: Hepatitis A does not cause a long-term infection. Your liver heals itself within about two months of the initial infection. Hepatitis A can be prevented with a vaccine.
Hepatitis B
Cause: Hepatitis B is a blood borne infection, meaning it is spread by direct contact with infected blood or bodily fluids. Specific examples of transmission include sharing dirty needles when injecting IV drugs, having sexual contact with an infected individual, or passing infection from an infected mother to her unborn child.
Length of Infection: This form of hepatitis causes chronic liver damage in a small percentage of infected individuals; however, many people recover from this within six months. Hepatitis B can cause cirrhosis, liver failure, and liver cancer. There is also a vaccine available to prevent Hepatitis B.
Hepatitis C
Cause: Hepatitis C is spread similarly to Hepatitis B. It is most commonly spread by sharing dirty needles for IV drug use or coming into contact with infected blood.
Length of Infection: The majority of people infected with Hepatitis C have this as a life-long infection. It can lead to cirrhosis. There is no vaccine for this form of Hepatitis. Many people with this infection have no symptoms until their cirrhosis is very advanced. Hepatitis C can also cause liver failure and liver cancer.
Hepatitis D, Hepatitis E, And Hepatitis G
"There also are viral hepatitis types D, E, and G. The most important of these at present is the hepatitis D virus (HDV), also known as the delta virus or agent. It is a small virus that requires concomitant infection with HBV to survive. HDV cannot survive on its own because it requires a protein that the HBV makes (the envelope protein, also called surface antigen) to enable it to infect liver cells. The ways in which HDV is spread are by shared needles among drug abusers, contaminated blood, and by sexual contact; essentially the same ways as HBV.
Individuals who already have chronic HBV infection can acquire HDV infection at the same time as they acquire the HBV infection, or at a later time. Those with chronic hepatitis due to HBV and HDV develop cirrhosis (severe liver scarring) rapidly. Moreover, the combination of HDV and HBV virus infection is very difficult to treat.
Hepatitis E virus (HEV) is similar to HAV in terms of disease, and mainly occurs in Asia where it is transmitted by contaminated water.
Hepatitis G virus (HGV, also termed GBV-C) was recently discovered and resembles HCV, but more closely, the flaviviruses; the virus and its effects are under investigation, and its role in causing disease in humans is unclear." -Medicine Net
Symptoms Of Hepatitis
The symptoms of hepatitis are similar for all three types:
- Fever
- Nausea and vomiting
- Loss of appetite
- Flu-like symptoms
- Fatigue and weakness
- Lack of nutrition
- Aching in the abdomen
- Pale or clay-colored stool
- Dark urine
- Yellowing of skin or eyes
Treatment
For acute hepatitis, the main treatment is symptom relief. Special consideration should be given to any medications that a patient takes to see the effect it may have on an impaired liver (i.e. Tylenol, which is very toxic to a damaged liver). The liver helps with the synthesis of many medications so, as a nurse, be aware of the compound impact medications may have (sedation may linger longer due to inadequate medication metabolism).
Chronic hepatitis (B and C) is managed mainly with medications to eradicate the virus. Patients should avoid alcohol and cigarettes which can aggravate the liver.
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