CIRRHOSIS OF THE LIVER, LIVER CANCER and HEPATITIS

CIRRHOSIS OF THE
LIVER,
LIVER CANCER
AND HEPATITIS
BY: ROMMEL LUIS C. ISRAEL III

CIRRHOSIS OF LIVER
• Cirrhosis is a complication of liver disease which
involves loss of liver cells and irreversible
scarring of the liver.
• Alcohol and viral hepatitis B and Care common
causes of cirrhosis, although there are many
other causes.
• Cirrhosis can cause weakness,loss of
appetite, easy bruising, yellowing of the skin
(jaundice),itching, and fatigue.
BY ROMMEL LUIS C. ISRAEL III
2

CIRRHOSIS OF LIVER
• Diagnosis of cirrhosis can be suggested by
history, physical examination and blood tests,
and can be confirmed by liver biopsy.
• Complications of cirrhosis
includeedema and ascites, spontaneous
bacterial peritonitis, bleeding from
varices, hepatic encephalopathy, hepatorenal
syndrome, hepatopulmonary syndrome,
hypersplenism, and liver cancer.
3

WHAT IS CIRRHOSIS
• Cirrhosis is a complication of many liver
diseases characterized by abnormal structure
and function of the liver.
• Cirrhosis is a consequence of chronic liver
disease characterized by replacement
of liver tissue by fibrosis, scar tissue and
regenerative nodules, leading to loss of liver
function.
4

COMMON CAUSES OF CIRRHOSIS
CAUSES
1.ALCOHOL
2.NON
ALCOHOLIC
FATTY LIVER
DISEASE
3.
CRYPTOGENIC
CIRRHOSIS
4.
CHRONIC
VIRAL
HEPATITIS
5.
INHERITED
DISORDER
6.AUTOIMMUNE
DISEASE
7.
BILIARY ATRESIA
8.DRUG
& TOXINS
5

PATHOPHYSIOLOGY
Cirrhosis is the final stage in many types of liver problems.
Cirrhosis liver has usually nodular consistency with bands of
scar tissue and area of regenerating fibrosis,
Extensive destruction of hepatocytes ,
Alteration in the vascular and lymphatic system and bile
duct channel.
Bile stasis and precipitating jaundice,
6

SIGN AND SYMPTOMS OF CIRRHOSIS
Common symptoms and signs of cirrhosis include:
• Yellowing of the skin (jaundice) due to the
accumulation of bilirubin in the blood
• Fatigue
• Weakness
• Loss of appetite
• Itching
• Easy bruising from decreased production of blood
clotting factor by the diseased liver.
• Abdominal distention
7

DIAGNOSTIC EVALUATION
• Patient history,
• Physical examination,
• Computerized tomography (CT or CAT) or
magnetic resonance imaging (MRI) scans
and ultrasound examinations of the abdomen .
• Abnormal elevation of liver enzymes in the
blood (such as ALT and AST.
• Liver cancer (hepatocellular carcinoma) may be
detected by CT and MRI scans or ultrasound of
the abdomen.
8

TREATMENT IN CIRRHOSIS OF LIVER
1. preventing further damage to the liver,
2. treating the complications of cirrhosis
3. liver transplantation.
9

PREVENTING FURTHER DAMAGE TO
THE LIVER
Consume a balanced diet and one multivitamin daily. impaired
absorption of fat soluble vitamins may need additional vitamins D and
K.
Avoid drugs (including alcohol) that cause liver damage. All patients
with cirrhosis should avoid alcohol.
Avoid nonsteroidal anti-inflammatory drugs (NSAIDs, for
example,ibuprofen)..
Eradicate hepatitis B and hepatitis C virus by using anti-viral
medications.
Remove blood from patients with hemochromatosis to reduce the
levels of iron and prevent further damage to the liver.
Suppress the immune system with drugs such
as prednisone andazathioprine (Imuran) to decrease inflammation of
the liver in autoimmune hepatitis..
10

Correction of nutritional deficiencies: with vitamins and nutritional
supplements and a high-calorie and moderate-to high-protein
diet.
Restrict sodium and water intake, depending on amount
of fluid retention.
Bed rest
Diuretic therapy: frequently with spironolactone (Aldactone), a
potassium-sparing diuretic that inhibits the action of aldosterone
on the kidneys. Furosemide (Lasix), a loop diuretic, may also be
used in conjunction with spironolactone to help balance potassium
depletion.
Symptomatic relief measures: such as pain medication and
antiemetics.
Treatment of other problems associated with liver failure:
Administration of lactulose (Cephalic) or neomycin (My-ciguent)
for hepatic encephalopathy.
11

TREATING THE COMPLICATIONS OF
CIRRHOSIS
• Edema and ascites. Retention of salt and water can lead
to swelling of the ankles and legs (edema) or abdomen
(ascites) in patients with cirrhosis. Doctors often advise
patients with cirrhosis to restrict dietary salt (sodium) and
fluid to decrease edema and ascites. The amount of salt in
the diet usually is restricted to 2 grams per day and fluid to
1.2 liters per day.
• Diuretics are medications that work in the kidneys to
promote the elimination of salt and water into the urine. A
combination of the
diureticsspironolactone (Aldactone)and furosemide
(Lasix) can reduce or eliminate the edema and ascites
12

• Abdominal paracentesis-when the diuretics do not work
(in which case the ascites is said to be refractory), a
long needle or catheter is used to draw out the ascitic
fluid directly from the abdomen, a procedure called
abdominal paracentesis.
• Bleeding from varices. If large varices develop in the
esophagus or upper stomach, patients with
cirrhosis are at risk for serious bleeding
due to rupture of these varices.Treatments
include medications and procedures to
decrease the pressure in the portal vein.
13

• Propranol-a beta blocker, is effective in lowering pressure in
the portal vein and is used to prevent initial bleeding and
rebleeding from varices in patients with cirrhosis.
• Octreotide (Sandostatin) also decreases portal vein pressure
and has been used to treat variceal bleeding.
• Transjugular intrahepatic portosystemic shunt (TIPS) is a
non-surgical, radiolotic procedure to decrease the pressure in the
portal vein. TIPS is performed by a radiologist who inserts a stent
(tube) through a neck vein, down the inferior vena cava and into
the hepatic vein within the liver. The stent then is placed so that
one end is in the high pressure portal vein and the other end is in
the low pressure hepatic vein. varices and prevents bleeding from
the varices. TIPS is particularly useful in patients who fail to
respond to beta blockers, variceal banding..
14

• A surgical operation to create a shunt
(passage) from the high-pressure portal vein to veins
with lower pressure can lower blood flow and pressure
in the portal vein and prevent varices from bleeding.
• Hepatic encephalopathy. Patients with an abnormal
sleep cycle, impaired thinking, odd behavior, or other
signs of hepatic encephalopathy usually should be
treated with a low protein diet and oral lactulose.
15

• Hypersplenism. The filtration of blood by an enlarged
spleen usually results in only mild reductions of red
blood cells (anemia), white blood cells (leukopenia) and
platelets (thrombocytopenia) that do not require
treatment. Severe anemia, however, may require blood
transfusions or treatment with
erythropoietin or epoetin alfa (Epogen, Procrit),
hormones that stimulate the production of red blood
cells.
• Spontaneous bacterial peritonitis (SBP). Patients
suspected of having spontaneous bacterial peritonitis
usually will undergo paracentesis. Fluid that is removed
is examined for white blood cells and cultured for
bacteria.
16

WHEN IS A LIVER TRANSPLANT
INDICATED FOR CIRRHOSIS
• A liver transplant is considered necessary when
complications cannot be controlled by
treatment. Liver transplantation is a major
operation in which the diseased liver is removed
and replaced with a healthy one from an organ
donor.
17

18

NURSING DIAGNOSES :
• Activity Intolerance related to fatigue, general debility,
and discomfort
• Imbalanced Nutrition: Less Than Body Requirements re-
lated to anorexia and GI disturbances
• Impaired Skin Integrity related to edema, jaundice, and
compromised immunologic status
• Risk for Injury related to altered clotting mechanisms
• Disturbed Thought Processes related to deterioration of
liver function and increased serum ammonia level.
19

DIETARY MANAGEMENT
• The diet should supply sufficient carbohydrates to maintain
weight,
• A low fat and low sodium diet diet is also suggested .
• If the patient has ascites or edema ,fluids as well assodium
should be restricted in the diet.
• Adequate rest and a stable environmental temperature
should be ensured to allow optimal use of calorie .
• Administer prescribed medication ,such as antacids
,antiemetics ,antidiarrheals to decrease gastric distress,
• Provide multivitamins in severe malnutrition .
• Frequently vitamins K injections are ordered to improve
blood clotting factors .
20

PREVENT INFECTION
• Prevention of infection is accomplished by adequate diet
,rest ,and avoidance of hepatotoxic substance ( alcoholic
beverages and medication and chemical toxic to the liver
).Before the discovery of antibiotics ,infection was the major
cause of motality in cirrhosis .
• Prognosis-The outcome in cirrhosis depends on the clients
ability to stop the intake of alcohol or any other substance
toxic to the liver .if biliary obstruction is the cause of the
cirrhosis ,the client must seek further medical or surgical
treatment .once extensive damage has occurred ,the client
will not recover and the disease will progress with
manifestation of liver failure.
21

LIVER CANCER
• Tumour of the liver are either primary or
metastasic.
• Primary liver tuors mmay arise from
hepatocytes ,connective tissue ,blood vessels ,or
bile ducts .
• These tumors are either benign or malignant
• Metastatic malignant tumours arise from the
gastrointestinal tract ,the lungs and the breast.
22

23

• 1.Malignant neoplastic disease of the
liver usually occurring as a metastasis
from another cancer; symptoms include
loss of appetite and weakness and
bloating and jaundice and upper
abdominal discomfort.
• 2.Liver cancer or hepatic cancer
(from the Greek hēpar, meaning liver)
is a cancer that originates in the liver.
24

• Incidence-Liver cancer occurrence has been
steadily increasing since the early 1980s in the
U.S. Before 2010, the American Cancer Society
estimated that 24,120 new cases and 18,910
deaths would occur in the U.S. during this year
(2010).
25

TYPES OF LIVER CANCER
• Hepatocellular carcinoma (HCC)
The most common type of liver cancer is
hepatocellular carcinoma and it is the result of a
tumor formed by the abnormal growth of the liver-
specific cells called hepatocytes (‘hepat’ and
‘hepato’ are derived from the Greek word for
liver). Most patients with this type of cancer are
over 50 and it is more common in males than in
females. Hepatocellular carcinoma can metastasize,
and when it does, it frequently goes to
nearby lymph nodes and to the lungs.
26

HEPATO CELLULAR CARCINOMA
27

CHOLANGIOCARCINOMA
• This kind of carcinoma, also known as bile duct
cancer, arises from the connective tissues of the
tubes that connect the liver to the gallbladder and
the gallbladder to the small intestine (hepatic bile
ducts) as well as the ducts, located inside the liver
(intrahepatic ducts).
• Most cholangiocarcinomas are adenocarcinomas
(they form in glandular tissue)but they frequently
grow slowly and don’t metastasize for long periods
of time.
28

HEPATOBLASTOMA
• Hepatoblastoma characteristically develops in
children; it is most frequently diagnosed in infants
between 14 and 24 months and almost all patients
are diagnosed by the age of 5. Older children and
adults can develop this carcinoma, but it is very
rare. This malignancy is the result of an
uncontrolled proliferation of undeveloped liver cells
(hepatocytes). Hepatoblastoma is usually found in
only one place (unifocal), it’s uncommon for it to
metastasize.
29

ETIOLOGY & PATHOPHYSIOLOGY
Incidence of primary cancer of the liver is increasing
in the United States in the younger population and
in females.
Cirrhosis, HBV, and HCV have been implicated in its
etiology.
Rarer associated causes are hemochromatosis;
alpha^an-titrypsin deficiency; aflatoxins; chemical
toxins, such as vinyl chloride and Thorotrast;
carcinogens in herbal medicines; nitrosamines; and
ingestion of hormones, as in oral contraceptives.
30

Arises in normal tissue as a discrete
tumor or in end-stage cirrhosis in a
multinodular pattern.
Liver metastasis reaches the liver by way
ofthe portal system or the lymphatic
channels or by direct extension from an
abdominal tumor.
31

LIVER CANCER: RISK FACTORS
Hepatitis C Virus (HCV):
Hepatitis C is the leading cause of both HCC and
chronic liver disease. It is of special importance
because unlike hepatitis B virus, there is no vaccine
available for hepatitis C virus.
Excessive alcohol intake:
Alcohol liver disease is the
second most common risk factor for HCC .
Geography:
ore than 80% of HCC cases appear in Eastern Asia and
Africa America.
32

Sex:
Males have a higher liver cancer rate than females. The
difference in the male:female ratio is greatest among
Europeans. The difference between the rates is likely
caused by different exposure to risk factors including
alcohol consumption, cigarettes, and infection with
hepatitis B virus (HBV) or hepatitis C virus (HCV). More on
HBV and HCV.
Age:
HCC incidence rate is in people 75 years old and older.
The peak age for African women occurs between 65 and
70 years old and then decreases.
33

Hepatitis B Virus (HBV):
In places with high HCC incidence rates, HBV is usually
transmitted from mother to child (vertical transmission),
whereas in areas with low HCC incidence rates patients
usually get infected with HBV through sexual and
parenteral ways (horizontal transmission). (3)
Obesity:
increase in cancer mortality in people with great body
mass index in contrast to those who had a normal body
mass index. Liver cancer is frequently found in patients
with metabolic disarrangements.
34

Diabetes Mellitus:
Many studies around the world have found a significant
relationship between diabetes and the development of
HCC.
smoking may be a higher risk factor for women than
men.
Exposure to aflotoxins:
Aflatoxins are a type of mycotoxin, toxic chemicals made
by some types of fungi. Aflatoxin is produced
by Aspergillus fungi when the fungus grows on
improperly stored food products. Aflatoxins are capable
of causing DNA mutations, including the tumor,
35

LIVER CANCER: SYMPTOMS &
DETECTION
Nonspecific symptoms that can be associated with HCC may
include:
Yellowish color of the skin (Jaundice)
Inability to eat (Anorexia)
Weight loss
Abdominal pain and/or swelling
Hepatomegaly
Diaphoresis
36

Fever
Most common presenting symptom is right upper
quadrating abdominal pain, usually dull or aching, and
may radiate to the right shoulder.
A right upper quadrant mass, weight loss, abdominal
distention with ascites, fatigue, anorexia, malaise, and
planned fever.
Jaundice is present only in a minority of patients at
diagnosis in primary cancer of the liver.
With portal vein obstruction, ascites and esophageal
varices occurs
37

DIAGNOSTIC EVALUATION:
• Increased levels of scrum bilirubin, alkaline
phosphate and liver enzymes. (AST & ALT)
• AFP(alpha fetoprotein)
• Ultrasonography and CT along with MRI
• PET scan
• CT scans and MRI
• Percutaneous needle biopsy
• Laparoscopy
38

MEDICAL MANAGEMENT
• Treatment of liver cancer is aimed at relieving
manifestation and supporting the client physically
and emotionally .The treatment option for medical
management include chemotherapy , radiation
therapy .
• Nonsurgical Treatment
• Neoadjuvant therapies for liver cancer, including
trans arterial chemoembolization, combination
chemotherapy, chemotherapy along with
radiotherapy, These therapies are used to reduce
the size of the tumor and make surgical excision
possible.
39

Liver cancer is radiosensitive, but treatment is
restricted-, by the limited radiation tolerance ofthe
normal liver.
Radiation therapy can help reduce pain and
discomfort of j large Unresectable tumors.
Chemotherapy is used as an adjuvant therapy after
surgical resection of liver cancer.
Systemic chemotherapy is the only treatment
applicable when the cancer has spread outside the
liver.
40

SURGICAL TREATMENT
CASES:
Surgical resection
Cryosurgery
Radiofrequency ablation
Liver transplantation
Care of the patient after liver surgery is similar to general
abdominal surgery.
41

NURSING MANAGEMENT
• Nursing diagnosis and intervention for clients with
liver cancers vary according to the amount of liver
dysfunction and the treatment modalities ,plan to
assess the client for metabolic malfunctions ,pain
,bleeding problem ,ascites ,edema ,jaundice and
endocrine complication .
Acute and Chronic Pain related to growth of tumor
• Intervention-Administer medication at the
prescribed time and dosage ,assist the client and
family members to gain knowledge about the
condition .
42

• Imbalanced Nutrition: Less Than Body Requirements related
to anorexia
• Intervention- Instruct the client to take low fat and sodium
diet ,provide multivitamin supplementation diet, After
surgery give low frequent diet and semisolid diet ,to the
patient
43

COMPLICATIONS:
Malnutrition,
Biliary obstruction with jaundice.
Sepsis,
Liver abscesses.
Fulminant liver failure
Metastasis
44

PROGNOSIS
Because hepatic tumors may be far advanced before clinical
manifestation or laboratory data indicate their presence ,and
severe liver disease ,liver cancer carries a poor prognosis
.most clients with hepatic carcinoma have a median survival
time of 3 to 6 months.
45

HEPATITIS
• INTRODUCTION-The word hepatitis comes from the
Ancient Greek word hepar(root word hepat) meaning
'liver', and the
Latin itis meaninginflammation. Hepatitis means injury
to the liver with inflammation of the liver cells. Hepatitis
is swelling and inflammation of the liver.
• Hepatitis is most commonly caused by a viral infection.
There are, however, other causes of hepatitis. These
include autoimmune hepatitis (a disease occurring
when the body makes antibodies against
the liver tissue) and hepatitis that occurs as a secondary
result of medications, drugs, toxins and alcohol.
46

DEFINITION
Hepatitis means injury to the liver with
inflammation of the liver cells. Hepatitis is swelling
and inflammation of the liver.
Hepatitis is most commonly caused by a viral
infection.
2. Inflammation of the liver, usually caused by
bacterial or viral infection, drugs (including
alcohol), toxins, or parasites. This disease is
characterized by an enlarged liver,
jaundice, diminished appetite, nausea,
andabdominal pain.
47

TYPES OF HEPATITIS
Acute hepatitis
Chronic hepatitis
Viral hepatitis
Toxic hepatitis
Alcoholic hepatitis
Fulminant liver disease
48

• There are five main types of hepatitis that are
caused by a virus,Hepatitis A(HAV), Hepatitis B
(HBV), Hepatitis C(HCV), Hepatitis D(HDV), and
Hepatitis E( HEV) – plus types Hepatitis X and
Hepatitis G.
• Hepatitis A - this is caused by eating infected food
or water. The food or water is infected with a virus
called HAV (Hepatitis A Virus). Anal-oral contact
during sex can also be a cause. Nearly everyone
who develops Hepatitis A makes a full recovery - it
does not lead to chronic disease.
49

HEPATITIS B
This is an STD (sexually transmitted disease). It is caused by the virus HBV
(Hepatitis B Virus) and is spread by contact with infected blood, semen, and
some other body fluids. You get Hepatitis B by:
Having unprotected sex (not using a condom) with an infected person.
Sharing drug needles (for illegal drugs like heroin and cocaine or legal drugs
like vitamins and steroids).
Getting a tattoo or body piercing with dirty (unsterile) needles and tools that
were used on someone else.
Getting pricked with a needle that has infected blood on it (health care
workers can get hepatitis B this way).
Sharing a toothbrush, razor, or other personal items with an infected person.
An infected woman can give hepatitis B to her baby at birth or through her
breast milk. Through a bite from another persons.
50

HEPATITIS C
The transmission and prevention of HCV is similar to that of
HVBHepatitis C is usually spread through direct contact with
the blood of a person who has the disease. It is caused by
the virus HCV (Hepatitis C Virus).
The liver can swell and become damaged. In hepatitis C,
unlike hepatitis B, liver cancer risk is only increased in people
with cirrhosis and only 20% of hep C patients get cirrhosis.
Feces is never a route of transmission in hepatitis C.
Donated blood is also tested for Hepatitis C. Hepatitis C.This
disease, hepatitis C has been considered by many specialists
to be an epidemic. It is also known as a silent illness, because
you can get hepatitis C for many years and not even know
that.
51

52

Hepatitis D - only a person who is already infected with
Hepatitis B can become infected with Hepatitis D. It is caused
by the virus HDV (Hepatitis D Virus). Infection is through
contact with infected blood, unprotected sex, and
perforation of the skin with infected needles. The liver of a
person with Hepatitis D swells.
Hepatitis E - The etiologies of hepatitis A through E that
cause acute viral hepatitis .a person can become infected by
drinking water that contains HEV (Hepatitis E Virus). The liver
swells but there is no long-term consequence. Infection is
also possible through anal-oral sex. General hygiene
precaution are necessary prevention of hepatitis E.
53

• Hepatitis X - if a hepatitis cannot be attributed to the viruses
of hepatitis A, B, C, D, or E, it is called Hepatitis X. In other
words, hepatitis of an unknown virus.
• Hepatitis G - this is a type of hepatitis caused by the
Hepatitis G virus (HGV). Usually there are no symptoms.
When there are symptoms they are very mild.
54

CAUSES OF HEPATITIS
Immunological damage
Toxic drug
Infections
• Causes of Non-Viral Hepatitis
• Alcohol
• Hepatitis can be caused by liver damage from excessive
alcohol consumption.
• Autoimmune Disease
55

PATHOPHYSIOLOGY
Due to any etiological factors (viral ,non viral ,toxic or
drug induced hepatitis)
Inflammation in liver cells
Necrosis in the liver cells
Produce a characteristics cluster of clinical ,biochemical
,and cellular changes .
Patient show sign and symptoms.
56

SIGNS AND SYMPTOMS OF
HEPATITIS
The acute phase of hepatitis - symptoms
The initial phase of hepatitis is called the acute phase. The
symptoms are like a mild flu, and may include:
Diarrhea
Fatigue
Loss of appetite
Mild fever
Muscle or joint aches
Nausea
Slight abdominal pain
Vomiting
Weight loss
57

 As the patient gets worse, these symptoms may follow:
 Circulation problems (only toxic/drug-induced hepatitis)
 Dark urine
 Dizziness (only toxic/drug-induced hepatitis)
 Drowsiness (only toxic/drug-induced hepatitis)
 Enlarged spleen (only alcoholic hepatitis)
 Headache (only toxic/drug-induced hepatitis)
 Hiv
 Itchy skin
 Light colored feces, the feces may contain pus
 Yellow skin, whites of eyes, tongue (jaundice)
 flu-like symptoms
 loss of appetite
58

HOW IS HEPATITIS
DIAGNOSED
Physical Exam
During a physical examination, your doctor may press down
gently on your abdomen to see if there is pain or tenderness.
He or she can also feel if the liver is enlarged. If your skin or
eyes are yellow, your doctor will note this during the exam.
Liver Biopsy
A liver biopsy is a minimally invasive test that involves the
doctor taking a sample of tissue from your liver. This is
closed procedure. In other words, it can be done through the
skin with a needle and does not require surgery. This test
allows the doctor to determine if an infection or
inflammation is present or if or liver damage has occurred.
59

• Liver Function Tests
• Liver function tests use blood samples to determine
how efficiently the liver works. These tests check how
the liver clears blood waste, protein, and enzymes. High
liver enzyme levels may indicate that the liver
is stressed or damaged.
• Ultrasound
• An abdominal ultrasound uses ultrasound waves to
create an image of the organs within the abdomen. This
test will reveal fluid in the abdomen, an enlarged liver,
or liver damage.
60

• Blood Tests
• Blood tests used to detect the presence of hepatitis virus
antibodies and antigen in the blood will indicate or confirm
which virus is the cause of the hepatitis.
• Viral Antibody Testing
• Further viral antibody testing may be needed to determine if
a specific type of the hepatitis virus is present.
61

HOW IS HEPATITIS TREATED?
• Hepatitis A
• Hepatitis A isn’t usually treated. Bed rest may be
recommended if symptoms cause a great deal of discomfort.
If you experience vomiting or diarrhea, you will be put on a
special diet created by your doctor to prevent malnutrition or
dehydration.
• Vaccination can also prevent HAV infections by helping your
body produce the antibodies that fight this type of infection.
Most children receive the vaccination between ages 12 and
18 months. Vaccination is also available for adults.
• There is no treatment specifically for hepatitis A. Doctor will
advise the patient to abstain from alcohol and drugs during
the recovery.
62

HEPATITIS B
• Acute hepatitis B doesn’t require specific treatment. Chronic
hepatitis B is treated with anti-viral medications. This form of
treatment can be costly, since the treatment must be
followed for several months or years. Treatment for chronic
hepatitis B also requires regular medical evaluations and
monitoring to determine if the virus is progressing.
• A patient with Hepatitis B needs to rest. He will require a diet
that is high in protein and carbohydrate - this is to repair
damaged liver cells, as well as to protect the liver. If this is
not enough, the doctor may prescribe interferon. Interferon
is an antiviral agent.
63

HEPATITIS C
Antiviral medications are used to treat both acute and
chronic forms of hepatitis C. People who develop chronic
hepatitis C are typically treated with a combination of
antiviral drug therapies. They may also need further testing
to determine the best form of treatment. People who
develop cirrhosis (scarring of the liver) or liver disease as a
result of chronic hepatitis C may be candidates for liver
transplantation.
A patient with Hepatitis C will be prescribed pegylated
interferon and ribavirine.
Hepatitis D
Hepatitis D is treated with a medication called alpha
interferon.there is no effective treatment for hepatitis virus D.
64

HEPATITIS E
• There are currently no specific medical therapies to
treat hepatitis E. Because the infection is often
acute, it typically resolves on its own. People with
this type of infection are often advised to get
adequate rest, drink plenty of fluids and nutrients,
and avoid alcohol.
• Non-Viral Hepatitis - If the patient has non-viral
hepatitis, the doctor needs to remove the harmful
substance. It will be flushed out of the stomach by
hyperventilation or induced vomiting. Patients with
drug-induced hepatitis may be prescribed
corticosteroids.
65

PREVENTION FROM HEPATITIS
Wash your hands with soap after going to the toilet
Only consume food that has just been cooked
Only drink commercially bottled water, or boiled
water if you unsure of local sanitation
Only eat fruits that you can peel if you are
somewhere where sanitation is unreliable
Only eat raw vegetables if you are sure they have
been cleaned/disinfected thoroughly
Get a vaccine for Hepatitis A if you travel to places
where hepatitis may be endemic.
66

HOW TO PREVENT HEPATITIS B
Tell the partner if you are a carrier or try to find out
whether he/she is a carrier
• Practice safe sex
• Only use clean syringes that have not been used by
anyone else
• Do not share toothbrushes, razors, or manicure
instruments
• Have a Hepatitis B series of shots if you are at risk
• Only allow well sterilized skin perforating
equipment (tattoo, acupuncture, etc.)
67

HOW TO PREVENT HEPATITIS C
• If you are infected do not let others share your
toothbrush, razor, manicure equipment
• If you are infected cover open wounds
• Do not share needles, toothbrushes, or manicure
equipment
• If your skin is to be pierced, make sure
equipment is well sterilized (tattoo, etc.)
• Go easy on the alcohol
• Do not share drug equipment.
68

HOW TO PREVENT HEPATITIS D
Use the same guidelines as for Hepatitis B. Only a person
who is infected with Hepatitis B can become infected with
Hepatitis D.
How to prevent Hepatitis E
Do the same as you would to protect yourself from
Hepatitis A infection.
How to prevent Alcoholic Hepatitis
Go easy on the alcohol, or abstain from consuming alcohol.
How to prevent Toxic/Drug Induced Hepatitis
Make sure you know about the lethal contents of all
chemicals.
Make sure the spray is not pointing at you.
69

DIETARY MANAGEMENT
• Recommonded small ,frequent meals.
• Provide intake of 2000 to 3000 Kcal/d during acute
illness .
• Carefully monitor fluid volume .
• Instruct patient to abstain from alcohol during acute
illness and for at least 6 month after recovery.
• Advise patient to avoid substance ( medications , and
toxins ) that may affect liver function .
70

NURSING MANAGEMENT
• for all patients:
• Imbalanced Nutrition: Less Than Body Requirements related
to effects of liver dysfunction.
• Deficient Fluid Volume related to nausea and vomiting
• Activity Intolerance related to anorexia and liver dysfunction
• Deficient Knowledge related to transmission
• For HBV patients:
• Risk for Injury related to liver function
• Disturbed Thought Processes related to encephalopathy be-
cause of impaired liver function
71

COMPLICATIONS OF HEPATITIS
72

chronic liver disease
cirrhosis (scarring of the liver)
cancer of the liver (in rare cases)
When the liver stops functioning normally liver failure
can occur. Complications of liver failure include:
bleeding disorders
build-up of fluid in the abdomen (the liver can no
longer rid the body of toxins and fluids; fluid can
become infected)
increased blood pressure in portal veins that enter
the liver (due to overall fluid retention)
73

• kidney failure (decrease kidney function occurs in patients with
liver failure and toxins build up in body)
• hepatic encephalopathy (fatigue, memory loss, diminished
mental abilities due to build up of toxins that affect the brain,
especially ammonia)
• hepatocellular carcinoma, liver cancer (occurs in 80 percent of
patients with cirrhosis and is commonly seen as a result of viral
hepatitis)
• People with chronic hepatitis C are encouraged to avoid
alcohol because it can accelerate liver disease. Certain
supplements, prescription, and over-the-counter
medications can also affect liver function. If you have
chronic hepatitis C, check with your doctor before
taking any new medications.
74

CIRRHOSIS OF THE LIVER, LIVER CANCER and HEPATITIS

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