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Y    Y
 Y  YY    Y
Ý Double shelled DNA hepadnavirus
Ý Spread by sex, blood, and body fluids
Ý Severe disease
Ý Prolonged illness
Ý Chronic problems in ~ 10%
Ý ×ncubation period: 45-
45-180 days, average 60-
Ý Onset insidious (subtle and treacherous)
Ý Symptoms more severe
Ý Malaise, arthralgias, rash, nausea & vomiting
Ý Often hospitalized
Ý One in 200 die from acute disease
Ý Chronic liver disease kills ten times as many

cepatitis -A cepatitis -B cepatitis -C cepatitis -D cepatitis -E

Causative cepatitis ƛ cepatitis -B cepatitis -C cepatitis -D cepatitis -E

organism A Virus Virus Virus Virus
Types of Non-
Non- Enveloped Single Deprive Single
Virus enveloped DNA Virus stranded RNA Virus stranded
RNA Virus RNA Virus RNA Virus

×ncubation 15--45 days

15 30-
30-180 15--160 days 30-
15 30-180 days 14-
14- 60
Period days days

Trans- Faeco-oral
Faeco- Parental, Parental, Parental, Faeco-oral
mission route,rarely blood--
blood blood--
blood blood--
blood route
blood products, products, products,
borne Perinatal, Perinatal, Perinatal,
Sexual etc. Sexual etc. Sexual etc.

   ×gM anti cAV cbsAg,×gM,anti cCV- RNA, Anti
cCV- ×gM anticDV,cDV ×gM Anti
cBC cBeAgcBV cCV Ag,cDV RNA cEV/×gG Anti
  ×gG anti cAV cbsAg,×gG,anti cCV- RNA, Anti
cCV- ×gG anti cDV Rarely
rarely cBC cCV

  ×gG anti cAV Anti cbs Anti cCV-

cCV- ×gG anti cDV -NA-
rarely ,×gG,anti cBC

  ×gG anti cAV Anti cbs -NA-

NA- -NA-
NA- -NA-

¬  Asymptmatic Fatal Asymptmatic Asymptmatic Co-

Co- Asymptmatic
  acute liver failure Acute /chronic Acute /chronic infection/superinfec Fatal acute liver
subclinical/rapidl subclinical/rapidl tion to cepatitis
cepatitis--B failure
y prograssive y prograssive

!  " Non specific ×nterferon+/-

×nterferon+/- ×nterferon+/-
×nterferon+/- Non specific Non specific
Lamivudine Rebiverine

    ×gG Vaccine cB×G None.aviod blood cBV Vaccine.aviod ×mprove

   ×mprove hygeine vaccine,aviod contaminatn,safe blood hygeine
blood sex contaminatn,safe
contaminatn,safe sex
Ý Virus present in blood, semen, saliva
Ý Percutaneous
Ý Contaminated needles (tattoos, piercing,
drugs, etc)
Ý Blood transfusion
Ý Perinatal
Ý Permucosal
Ý Sexual contact
Ý Continuous close contact

#   $
Blood semen urine
Serum Vaginal fluid feces
wound exudates Saliva sweat
breast milk
Ý 0ellowish eyes and skin called jaundice
Ý Swollen stomach or ankle
Ý Easy bruising
Ý Tiredness
Ý Upset stomach
Ý Fever
Ý Loss appetite
Ý Diarrhea
Ý Light colored stool
Ý Dark yellow urine
c  S  
×gM anti-
anti-cBc (core antibody)
Ý Appears early
Ý Persists for 6 months
cBsAg (surface antigen)
Ý Detectable 30-
30-60 days after exposure
Ý May indicate chronic carrier status
cBsAb (    Y
(    Y    )
Ý Develops after resolved infection
Ý ×ndicates long term immunity
Anti--cBc/cBcAb (antibody to core antigen)
Ý Develops in all cBV infections
cBeAg (E antigen)
Ý ×ndicates cBV replication
Ý Correlates with high infectivity
Ý Present in acute or chronic infection
Anti--cBe (antibody to E antigen)
Ý Develops in most cBV infections
Ý Correlates with lower infectivity
"   S
90% of infants Risk of chronic
30% of 5 year
Î infection is lower
after acute illness
6% of adults
c  S
Ý Many prostitutes in the Philippines,
Thailand, and developing countries are
hepatitis B carriers

Ý Sexual activity is #1 risk factor in U.S.

c  # 
Ý Education
Ý Needles, sex, universal precautions
Ý Vaccine
Ý Pre--exposure, active immunity
Ý cB×G
Ý Post-exposure
Ý Passive immunity
Ý ×nterferon - for cBeAg +ve carriers with
chronic active hepatitis. Response
Ý rate is 30 to 40%.
Ý alpha--interferon 2b (original)
Ý alpha--interferon 2a (newer, claims to be
more efficacious and efficient)
Ý Lamivudine - a nucleoside analogue
reverse transcriptase inhibitor. Well
Ý tolerated, most patients will respond
favorably. cowever, tendency to relapse
on cessation of treatment. Another
problem is the rapid emergence of
drug resistance.
Ý Adefovir ƛ less likely to develop resistance
than Lamivudine and may be used
Ý to treat Lamivudine resistance cBV.
cowever more expensive and toxic
Ý Entecavir ƛ most powerful antiviral known,
similar to Adefovir
Ý Successful response to treatment will
result in the disappearance of cBsAg,
Ý cBV--DNA, and seroconversion to cBeAg

Ý Liver transplantation
N  $

Ý Fatigue R/T Decreased metabolic energy

Desire outcome:
Report improved sense of energy
Perform ADLs and participate in
desire activity at level of ability.
Promote bedrest/chair during
toxic state.
Ý Provide quiet environment limit visitor as
Ý Recommend change position frequently.
Ý Encourage use of stress management
techniques. (e.g progressive relaxation,
radio tv, reading
Fluid volume, risk for deficiency risk factor
excess losses through vomiting and diarrhea 3rd
space shift altered clotting factor
Desire outcome:
maintain adequate hydration, AEB stable
vital signs, good skin turgor, capillary refill, and
strong peripheral pulses.
Ý Monitor × and O compare with periodic
weight note enteric losses e.g vomiting and
Ý Asess vital sign and peripheral pulses,
Skin turgor, and mucous membrane.
Ý Check for ascites edema formation
measure abdominal girth as indicated.
Ý Observe for signs of bleeding e.g
hematuria melena,
Self esteem, situational low R/T annoying
debilitating symptoms, confinement isolation,
length of illness recovery period.
Desire outcome:
verbalization of change in lifestyle, fear of
rejection, reaction of others negative feelings
about the body, feeling of helplessness.
Ý Contract with patient regarding time for listening

Ý encourage discussion of feeling and concern.

Ý Asess effect of illness in economic factors
of patient and S.O
Ý offer diversional activities based on
energy level