1. General information
    1. Widespread inflammation of the liver tissue with liver cell damage due to hepatic cell degeneration and necrosis; proliferation and enlargement of the Kupffer cells; inflammation of the periportal areas (may cause interruption of bile flow)
    2. Hepatitis A
      1. Incubation period: 15-45 days
      2. Transmitted by fecal/oral route: often occurs in crowded living conditions; with poor personal hygiene; or from contaminated food, milk, water, or shellfish
    3. Hepatitis B
      1. Incubation period: 50-180 days
      2. Transmitted by blood and body fluids (saliva, semen, vaginal secretions): often from contaminated needles among IV drug abusers; intimate/sexual contact
    4. Hepatitis C
      1. Incubation period: 7-50 days
      2. Transmitted by parenteral route: through blood and blood products, needles, syringes
  2. Assessment findings
    1. Preicteric stage
      1. Anorexia, nausea and vomiting, fatigue, constipation or diarrhea, weight loss
      2. Right upper quadrant discomfort, hepatomegaly, splenomegaly, lymphadenopathy
    2. Icteric stage
      1. Fatigue, weight loss, light-colored stools, dark urine
      2. Continued hepatomegaly with tenderness, lymphadenopathy, splenomegaly
      3. Jaundice, pruritus
    3. Posticteric stage
      1. Fatigue, but an increased sense of well-being
      2. Hepatomegaly gradually decreasing
    4. Diagnostic tests
      1. All three types of hepatitis
        1. SGPT (ALT), SGOT (AST), alkaline phosphatase, bilirubin, ESR: all increased (preicteric)
        2. leukocytes, lymphocytes, neutrophils: all decreased (pericteric)
        3. prolonged PT
      2. Hepatitis A
        1. hepatitis A virus (HAV) in stool before onset of disease
        2. anti-HAV (IgG) appears soon after onset of jaundice; peaks in 1-2 months and persists indefinitely
        3. anti-HAV (IgM): positive in acute infection; lasts 4-6 weeks
      3. Hepatitis B
        1. HBsAg (surface antigen): positive, develops 4-12 weeks after infection
        2. anti-HBsAG: negative in 80% of cases
        3. anti-HBc: associated with infectivity, develops 2-16 weeks after infection
        4. HBeAg: associated with infectivity and disappears before jaundice
        5. anti-HBe: present in carriers, represents low infectivity
      4. Hepatitis C: no specific serologic tests
  3. Nursing interventions
    1. Promote adequate nutrition.
      1. Administer antiemetics as ordered, 30 minutes before meals to decrease occurrence of nausea and vomiting.
      2. Provide small, frequent meals of a high-carbohydrate, moderate- to high-protein, high-vitamin, high-calorie diet.
      3. Avoid very hot or very cold foods.
    2. Ensure rest/relaxation: plan schedule for rest and activity periods, organize nursing care to minimize interruption.
    3. Monitor/relieve pruritus (see Cirrhosis of the Liver).
    4. Administer corticosteroids as ordered.
    5. Institute isolation procedures as required; pay special attention to good hand-washing technique and adequate sanitation.
    6. In hepatitis A administer immune serum globulin (ISG) early to exposed individuals as ordered.
    7. In hepatitis B
      1. Screen blood donors for HBsAg.
      2. Use disposable needles and syringes.
      3. Instruct client/others to avoid sexual intercourse while disease is active.
      4. Administer ISG to exposed individuals as ordered.
      5. Administer hepatitis B immunoglobulin (HBIG) as ordered to provide temporary and passive immunity to exposed individuals.
      6. To produce active immunity, administer hepatitis B vaccine to those individuals at high risk.
    8. In non-A, non-B: use disposable needles and syringes; ensure adequate sanitation.
    9. Provide client teaching and discharge planning concerning
      1. Importance of avoiding alcohol
      2. Avoidance of persons with known infections
      3. Balance of activity and rest periods
      4. Importance of not donating blood
      5. Dietary modifications
      6. Recognition and reporting of signs of inadequate convalescence: anorexia, jaundice, increasing liver tenderness/discomfort
      7. Techniques/importance of good personal hygiene