11.15 Hepatitis
The term hepatitis means inflammation of the liver. Hepatitis can be an acute or a chronic condition. When it lasts for six months or less, it is considered acute, and when it lasts over six months, it is considered chronic. The severity of hepatitis can range from mild to severe based on the source of the inflammation.[1]
Pathophysiology
Hepatitis is commonly caused by the viruses of hepatitis A, B, C, D, and E. Hepatitis A, B, and C are the most common viral causes. Hepatitis A is commonly transmitted via the fecal to oral route and is common in places where there is poor sanitation. Hepatitis B and C are transmitted via contact with infected body fluids via contaminated blood transfusions, sharing of needles, or other parenteral measures. Hepatitis B and C can also be transmitted sexually and via pregnancy/childbirth. The incubation period for viral hepatitis ranges from four to twelve weeks, depending on the specific virus. Hepatitis A is usually an acute condition, but hepatitis B and C can become chronic illnesses and can lead to liver cancer or other complications.[2]
Hepatitis D is inflammation of the liver that requires the presence of hepatitis B virus for viral replication. Hepatitis D infection cannot occur in the absence of hepatitis B virus, but it occurs concurrently or after being infected with Hepatitis B virus. Hepatitis E is transmitted mainly through contaminated drinking water and is common in low- and middle-income countries with limited access to essential water, sanitation, hygiene, and health services. The infection is usually self-limiting and resolves within two to six weeks. Occasionally, serious complications such as acute liver failure develops, which can be fatal.[3]
Hepatitis is also linked to a variety of autoimmune disorders. Autoimmune hepatitis is when the body develops antibodies that attack the liver that are triggered by exposure to certain drugs or viruses.[4]
Hepatitis can also be caused by the misuse of alcohol or drugs that can lead to death of liver cells, but the exact mechanism of action is unclear.[5]
Assessment
Regardless of the causes of hepatitis, the signs and symptoms are similar. Common early signs and symptoms of hepatitis are loss of appetite, nausea, vomiting, and fatigue. It can also be asymptomatic. As the disorder progresses, jaundice, pain in the right upper quadrant, an enlarged liver, light-colored stools, and dark-colored urine may occur. In severe cases of autoimmune and alcoholic hepatitis, clients may also have excessive fluid buildup in the abdomen referred to as ascites and mental status changes related to the buildup of toxins, such as ammonia, referred to as hepatic encephalopathy.[6]
Common Laboratory and Diagnostic Tests
Lab values that may be altered in hepatitis are liver enzymes, bilirubin, coagulation labs, and ammonia levels. Coagulation labs such as prothrombin time (PT) and internalized normalized ratio (INR) may be increased due to the liver’s role in