Main objective patients and families know about the ways of monitoring, controlling and managing the disease on completion of this chapter it is expected that a patient with hepatitis:
Describe the process of hepatitis
Identify the various types of hepatitis
Identify the transmission routs of hepatitis
Describe diagnostic tests
Define treatment measures
Identify medication regimen
Explain the medication's side effects
Describe the prevention rules to prevent hepatitis from being transmitted to the households and community
Identify the precipitating factors of hepatitis
Describe the required preparations related to the diagnostic test
Explain the ways of managing sexual problems and its prevention measures
State the importance of follow-up plan
Discuss measures to manage complications
Explain the measures to protect liver
Identify the involvement of other body organs
Explain the pregnancy related issues in a patients with Hepatitis
Identify the alternative and Complementary medicine to manage the condition
At the end of this chapter, it is expected that the family of patients with Hepatitis:
Describe the process of hepatitis
Identify the various types of hepatitis
Identify the transmission routs of hepatitis
Describe hepatitis diagnostic tests
Name different treatment plans for hepatitis
Identify safety measures to prevent transmission
Describe the measures for providing
Describe the measures for providing psychological to patients with hepatitis
2. What is hepatitis?
It is a systemic and viral infection, in which the inflammation of liver cells and necrosis occur and these changes lead to biochemical and cellular clinical alterations. Literally, hepatitis means the "inflammation of liver". The most important factors causing it are viruses. Alcoholic drinks, medicines, poisons and some hereditary diseases also bring about hepatitis . Hepatitis is divided into two kinds of chronic and acute .
In acute hepatitis, the diseases lasts for less than 6 months and finally leads to the complete removal of liver damage and the return of liver structure and function to normal level or leads to the immediate progression of acute damage toward extensive necrosis and the demise of patient. However, in chronic hepatitis, the process of disease lasts more than 6 months and patients does not have clinical symptoms .
Most patients suffering from viral hepatitis do not have any symptoms and their disease is diagnosed by doing medical tests. Nonetheless, the acute symptoms of disease exist in some patients. Following the contact with the virus causing hepatitis and going through a period, which varies from a week to a few months and is called the latent period, the acute symptoms of suffering from viral hepatitis would emerge, which include: lack of appetite, excessive fatigue, exhaustion and vomit, abdominal pain, darkening of urine, paling of stool and turning of skin into yellow . The symptoms of the disease usually last for days or weeks and its symptoms would be eradicated automatically. It must be attended that symptoms resembling influenza could be seen as muscular pain, exhaustion, and slight fever days or weeks before the emergence of the disease acute symptoms .
3. Acute hepatitis symptom
Pain at the right and the upper abdominal area is due to the exposure of liver capsule to traction and it is removed by the amelioration of the disease. Getting jaundiced means the yellowness of the skin and eyes. It must be attended that most patients suffering from hepatitis A and C do not have any symptoms of acute hepatitis, esp. jaundice. Some patients complain of bodily irritation which could be rooted in liver damage. Joint-related pain is also a part of acute hepatitis syndromes . In case of the progression of hepatitis, there is the likelihood of swell in stomach and inflammation of feet which could lead to digestive bleeding.
Five types of hepatitis have been found; A, B, C, D, and E. types A and E are akin with regard to the way of transmission (the stool-oral path). Types B, C and D are also similar to each other .
4. Viral hepatitis, type A
The suffering patient must not prepare any food for family members. Also, she/he must not participate in carrying food to table (work prohibition at restaurants and fast food outlets).
There ought not to be any sharing of bathroom toiletries between the suffering individual and other family members. The individual suffering from hepatitis is detected through symptoms, signs, physical examination and blood tests. A positive blood test usually pops up 5 days before the emergence of symptoms and remains unchanged up to 6 months after infection. There is no treatment for hepatitis A, although most individuals recuperate by supportive treatments. The individuals must be trained not to refer back to their work office or school until they have fever or jaundice or their appetite returns. Throughout the recuperation period, it is mandatory to refrain from drinking alcohol or taking non-prescribed medications.
There are two vaccines available for preventing Hepatitis A-related infection, namely as VAQTA and HAVRIX. Those who receive two dosages of these vaccines would be immune [14, 15].
5. Hepatitis E
Patients must have enough rest at the chronic phase of the disease. Patients can gradually resume their activities after feeling healthy and examining their laboratorial tests. However, after being active, they ought to rest and avoid taking part in drudgeries .
Rinsing and disinfecting fruits and vegetables, not using polluted water and foods (boiling water for one minute deactivates hepatitis virus) and not using personal things of others .
6. Hepatitis B
It must be mentioned that at-risk individuals might be afflicted with the virus of hepatitis B via using polluted blood products, contact of polluted blood with eyes, mouth, bleeding or damaged skin of healthy people, transfer from mother to fetus, tattooing and cupping, sexual contact, non-sterile dental and medical devices, esp. shared and non-sterile syringe, razorblade or toothbrush. This virus is not transferred through shaking hand, kissing or going to pool .
The infant born from a mother infected with hepatitis virus B ought to receive immune globins within 12hours after birth .
An individual who has been at exposure to hepatitis virus B and has not ever been afflicted with hepatitis and has not received vaccine must receive the immune globins injection at most 24 hours after contact with the virus .
Patient must take rest till the ebbing of hepatitis symptoms like liver inflammation, jaundice, and decrease in high liver enzymes (sometimes up to 3 to 4 months).
At the chronic phase of the disease, which entails a limit on protein and fat intake, patient must at several meals with a low volume of food intake.
In case of vomiting, taking of all medications must be avoided. If it is not stopped, patient must refer to doctor and avoid drinking alcohol, refrain from sexual intercourse or in case of having sex, condom must be used [2,8].
In case of need, medications must be taken only with doctor's prescription. After recuperation (usually 18 months afterward), patient must refer to doctor for undergoing checkups and laboratorial tests. It is recommended to healthy carriers to undergo the required checkups and laboratorial tests once every six months at the first year of the disease and after that once every year. In case of going to dentist's, doctor's, laboratory or anywhere in which the possibility for the transmission of the virus exists, it is recommended to patient to inform the health personnel there about the positive nature of their disease and show their special card . Patient must be trained not to use bathroom toiletries in a shared manner. Toothbrush, nail clipper, shaving machine, thermometer and cosmetics must be absolutely personal.
7. Hepatitis C
This virus is not transmitted through nestling, breastfeeding, sneeze, water, food, sudden contact and shared dishes.
Besides, they are recommended to drink abundant liquids (8 liters daily) and to eat foods that have a lot of vitamin and minerals, like fresh fruit juices (without food limitations). In addition, they are advised to eat foods at several meals in low volume and to use ginger for relieving vomit [9,22].
The individuals who are afflicted with Hepatitis C are recommended to inform the personnel at medical centers, dentist's, laboratories or nay other places which entails the possibility of virus transmission . It must be explained to patient to refrain from taking acetaminophen, anti-convulsion medications, alcohol, etc. In case of having dry mouth, they are recommended to drink water frequently in a sipping manner and to chew sugar-free gums.
They are also advised to follow the hygiene of mouth and teeth. Cutting down on sugary drinks and foods, using florid supplements once a day, using floss, snit-microbe mouthwash, reducing cigarette and quitting it, regular examination of teeth, their whitening and taking care of false teeth are among the tips given to these patients .
8. Hepatitis D
Among the most important causes of Cirrhosis are chronic hepatitis B and C, excessive consumption of alcoholic drinks, disturbances in the exiting tract of blood from liver, increase of iron in liver, etc.
They are also recommended to use all other proteins except red meat, including of herbal protein, fish, chicken, etc. and also to refrain from drinking alcohol and take vitamins, esp., A, C and K.
Eating foods in several mealtimes with low volume (instead of 3 meals, having six meals) and having a nutritional diet full of calorie and average amounts of protein (1 gram per each kilogram of protein) with limitations for using salt are among other tips [26,27]
Using ice cubes is conducive for relieving vomit and constipation alongside taking liquids and exercising are also recommended. Skincare is possible through changing lifestyle, using alcoholic soaps and liquids for cleansing the skin and applying softeners for massaging the skin while exercising the joints and limbs.
They are also advised to go to doctor in case of having blood (clot, nasal or gum bleeding and the existence of blood in stool) and to use soft-bristle toothbrush. Patients must gently clean their nose and use cold compress for decreasing their bleeding. Eating foods full of vitamin C is also recommended. Supportive measures are also recourse to for preventing deterioration.
Patients must measure their stomach with a meter on a daily basis and observe the limitation on using salt and liquids, they ought to report any symptoms to doctor. There are no limitations on activities but in case of having fever, bleeding and all other problems, caution must be exercised. Since the metabolism of most medicines is carried out through liver, it is recommended to avoid wishful consumption of medicines [25,26].
10. Sexual functioning training
Chronic hepatitis infection brings about changes in the hormone levels of body. In short, these patients experience the following conditions:
disturbance in the function of testicles
body hair loss
increase in breast size (genichomasty)
improper distribution of fat in body (fat accumulation in special parts of body).
disturbance in erection
Irrespective of patients' gender, these patients experience sexual disturbances at different dimensions and in case of consuming alcohol by these patients, they become susceptible in sexual issues which require more serious and costly measures. The continuation of sexual disturbances brings about effect on the quality of life among these individuals.
Hepatitis C information Center It is necessary to train these patients to consult with doctor or nurse in case of having sense of stimulation, pain at the time of stimulation, incapability in erection, incapability in maintaining erection for making sexual contact, delay in ejaculation or lack of ejaculation despite having enough stimulants, lack of ability in controlling or scheduling ejaculation and finally reaching to sexual climax. A good sexual partner has a significant role in solving sexual problem [28,29].
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