1.

CIRRHOSIS OF LIVER
2.LIVER CANCER
3.HEPATITIS
PRESENTED BY,
MS.MONARANI
M.SC.NURSING 1ST YEAR.
 1.CIRRHOSIS OF LIVER

 INTRODUCTION-
 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.
 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.
 Definition of cirrhosis
 1.Cirrhosis is a complication
of many liver diseases charact-
erized by abnormal structure
and function of the liver.
 2.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.
 common causes of cirrhosis
8.DRUG
CAUSES & TOXINS
1.ALCOHOL

6.AUTOIMMU
NE
2.NON DISEASE
ALCOHOLIC 7.
FATTY LIVER BILIARY
DISEASE ATRESIA

3. 4. 5.
CRYPTOGENI CHRONIC INHERITED
C VIRAL DISORDER
CIRRHOSIS HEPATITIS
 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,
 SIGN AND SYMPTOMS OF
CIRRHOSIS
 More 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
 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.
 TREATMENT IN CIRRHOSIS
OF LIVER
 1) preventing further damage to the
liver,
2) treating the complications of cirrhosis
3) liver transplantation.
1)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..
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 deple-
tion.
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.
 2)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
 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.
 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..
 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.
 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.
 3)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.
 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.
 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 .
 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.
 Liver cancer
 Introduction- Tumour of the liver are
either primary or metastasic. Primary liver
tuours may 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.
 DEFINITION
 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.
 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).

 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.
Hepato cellular carcinoma
 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.
 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.
 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.
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.
 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:
More than 80% of HCC cases appear in Eastern Asia
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:
In 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.
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.
Diabetes Mellitus:
Many studies around the world have found a significant
relationship between diabetes and the development of
HCC.
Tobacco: 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,
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
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
 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
 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.
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.
 Surgical Treatment
CASES:
Surgical resection
Cryosurgery
Radiofrequency ablation
Liver transplantation
Care of the patient after liver surgery is
similar to general abdominal surgery.
 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 .
 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
 COMPLICATIONS:
Malnutrition,
Biliary obstruction with jaundice.
Sepsis,
Liver abscesses.
Fulminant liver failure
Metastasis
 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.
 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.
 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.
 TYPES OF HEPATITIS
 Acute hepatitis
 Chronic hepatitis
 Viral hepatitis
 Toxic hepatitis
 Alcoholic hepatitis
 Fulminant liver disease
 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.
 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.
 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.
 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.
 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.
 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
 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.

 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
 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
 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
 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.
 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.
 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
 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.
 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
 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.
 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.
 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.)
 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.
 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.
 DIETARY MANAGEMENT
 Recommonded small ,frequent meals.
 Providw 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 .
 NURSING MANAGEMENT
 for all patients:
 Imbalanced Nutrition: Less Than Body Requirements re-
lated to effects of liver dysfunction.
 Deficient Fluid Volume related to nausea and vomiting
 Activity Intolerance related to anorexia and liver dysfunc-
tion
 Deficient Knowledge related to transmission
 For HBV patients:
 Risk for Injury related to liver function
 Disturbed Thought Processes related to encephalopathy
because of impaired liver function
Complications of Hepatitis
  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)
  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.