Basic Concepts of Hepatitis
1 . understanding Hepatitis
Hepatitis is a diffuse inflammatory process in tissues that can be caused by viral infection and by the toxic reactions to drugs and chemicals . ( Sujono , 1999) .
Acute hepatitis is an acute infectious disease with the main symptom is closely related to the presence of necrosis in the liver ( Mansjoer , 1999) .
Acute viral hepatitis is an infectious disease that is spread widely in the body , although the striking effect occurs in the liver ( Price, 1995) .
Chronic viral hepatitis , is a collection of heart disease due to various causes with more severity than six months ( Batticaca , 2009) .
Hepatitis A or infectious hepatitis is a disease is transmitted through oral contamination - pekal poor hygiene or contaminated food ( Suzanne , 2001) .
2 . Etiology of Hepatitis A
According Batticaca , (2009 ) that cause hepatitis are as follows a) . Virus , hepatitis A virus ( HAV ) was once known as infectious hepatitis with an incubation period ranging from 15-45 days , or three to four weeks , not two nanometer -sized capsule , heat resistant , and acid resistant virus is present in the stool of patients , b ) . Alcohol causes alcoholic hepatitis and alcoholic cirrhosis subsequently became , c ) . Medications causing toxic to the liver , so it is often called toxic hepatitis and acute hepatitis , d ) . Bacterial agents , by physical or chemical injury can cause nonviral hepatitis .
3 . Hepatitis classification
Some viruses are known to menginfersikan hepatitis A , hepatitis B , hepatitis C , hepatitis D , hepatitis E.
1 . Hepatitis A / Hepatitis is an infectious disease transmitted through oral - pekal contamination due to poor hygiene / food contaminated .
2 . Hepatitis B / serum hepatitis is a disease that is serious and is usually transmitted through contact with blood containing the virus . The disease is also transmitted through sexual intercourse and can be found by other body fluids cement .
3 . Hepatitis C / Hepatitis non - A non - B . This virus is a common cause of infection to blood -borne supali commercial . Hepatitis C is transmitted together with hepatitis B mainly through blood transfusion .
4 . Hepatitis D / hepatitis delta and actually is a defective virus that he himself can not infect hipatosit to cause hepatitis . Hepatitis D is transmitted like hepatitis B. Hepatitis D antigen and antibody can be checked on a blood donor .
5 . Hepatitis E was identified in 1990. This virus is a virus that is transmitted through ingestion of contaminated water . Most of the reported cases are found in developing countries .
4 . Pathophysiology and Basic Human Needs Irregularities In Clients With Hepatitis .
Inflammation spreads to the liver ( hepatitis ) can be caused by viral infection and by the toxic reactions to drugs and chemicals . The basic functional unit of the liver is called lobul and this unit is unique because it has its own blood supply . Often with the development of inflammation in the liver , the liver disrupted the normal pattern . Disruption of the normal blood supply to the liver cells causing necrosis and damage to the liver cells . After passing his time , the liver cells become damaged disposed of by the body's immune system response and replaced by a new liver cells healthy . Therefore , most of the clients who have hepatitis recovered with normal liver function is the metabolism of amino acids . Hearts change the amino acid excess into fat , produce hemoglobin which is the basic ingredient of bile , and the change in the absorption of nutrients from the gut , ( Price and Wilson , 1995) .
Inflammation of the liver due to viral invasion would lead to an increase in body temperature and heart 's capsule stretch lead to feelings of discomfort in the upper right quadrant of the abdomen . This is manifested by the presence of nausea and pain in the gut .
Onset of jaundice because the liver parenchymal cell damage . Although the number of billirubin that has not undergone conjugation into the liver remained normal , but due to liver cell damage and intra- hepatic bile duktuli , then there is the difficulty of transporting billirubin in the liver . There was also a difficulty in terms of conjugation . Consequently billirubin imperfect issued through the hepatic duct , due to retention ( due to the excretion of cell damage ) and regurgitation in duktuli , bile has not undergone conjugation ( indirect bilirubin ) , and bilirubin were already experiencing conjugation ( direct bilirubin ) . So here jaundice arising mainly due to difficulties in transport, conjugation and excretion of bilirubin ( price and wilson , 1995 )
Feces contain little sterkobilin therefore , pale stools ( abolis ) . Because the water-soluble bilirubin conjugation , bilirubin can be excreted into the urine , resulting in urine and urinary bilirubin dark . Elevated levels of conjugated bilirubin can be accompanied by an increase in bile salts in the blood that would cause itching and jaundice .
1 . Clinical Manifestations of Hepatitis
Signs and symptoms of hepatitis A viral hepatitis type A hepatitis A outbreak that the child typically cause symptoms in adults when there are symptoms such as fatigue , fever , nausea , abdominal pain , yellow eyes and loss of appetite . The symptoms will disappear altogether in the incubation period of six to twelve weeks . People who have received the hepatitis A outbreak will be immune to the disease . Unlike hepatitis B and C , hepatitis A outbreak led to the enactment of chronic hepatitis .
In general, signs and symptoms of hepatitis according Eltzer & Suzanna , (2001 ) is as follows :
1 . Incubation period , each kind of different hepatitis viruses , A Virus shoots past 15-45 days (average 25 days ) , virus B shoots past 40-180 days ( average 75 days ) , non- A and non Viruses B - tunasnya15 past 150 days (average 50 days ) .
2 . Phase Pre jaundice
Complaints are generally not typical . Complaints caused by a viral infection lasts about two to seven days . Decreased appetite ( first arose ) , nausea, vomiting , upper right abdomen ( solar plexus ) felt ill . The whole body aches , especially in the waist , shoulders and malaise , irritability fatigue , increased body temperature of around 39oC lasts for two to five days , headache , and joint pain .
3 . phase jaundice
Concentrated tea-colored urine , pale stools , decreased body temperature accompanied by bradycardia . Jaundice of the skin and sclera continues to increase in the first week , then settled and the new reduced after 10-14 days . Sometimes accompanied by itching all over the body pasa , lethargy and irritability capeh flavor felt for one to two weeks . Healing phase began when the disappearance of the signs of jaundice , nausea , pain in the pit of the stomach , followed by increased appetite on average 14-15 days after the onset of jaundice , the color looks normal people start to feel fresh again .
2 . examination Support
As for the investigation of patients with hepatitis is as follows
a. laboratory
Liver function tests : abnormal ( 4-10 times normal ) note : a limit value for distinguishing viral and non- viral hepatitis , AST ( SGOT ) ALT ( SGFT ) : initially increased , rising to 102 weeks before jaundice then seemed to decline , complete blood : HR decreased in relation to the decrease in human life ( liver enzyme disorders ) or result in bleeding , Leokopenia : thrombocytopenia may exist ( splenomegah ) , complete blood differentiation : leukocytosis , monositasi , atipikel lymphocytes , and plasma cells , alkaline fostosme complete : leukocytosis , monocytosis somewhat increased ( unless there is a heavy leukstasis ) , feces : color clay , steahorea (decreased liver function ) , serum albumin : decreased , blood sugar , hyperglycemia transfer / hypoglycemia ( impaired liver function ) , Anti- HAV IgM : Positive on type A , HBs AG : Positive DPT ( type B ) or negative ( type A ) note : a diagnostic before clinical symptoms occur , protombin period : may elongate ( liver dysfunction ) , serum Silirobin : above 2.5 mg / 100 ml when above 200 mg / ml of a poor prognosis may be related with an increase in secondary necrosis . Tereksfesi ESP : increased blood levels , liver biopsy : diagnosis and shows the extent of necrosis .
b . Radiology
The radiological examination in patients with hepatitis A is is as follows a) . X-ray examination of the abdomen , b ) . Displacement careful with technetium preparations , gold , or rose bengal labeled radioactive , c ) . Kolestogram , d ) . Kalangiogram , and e ) . Celiac arteriography blood vessels .
c . additional examination
Additional examination in the case of hepatitis is laparoscopy and liver biopsy .
3 . management
Treatment of viral hepatitis is primarily suporsif and include : Rest as needed , health education regarding avoiding use of alcohol / drugs , health education about the modes of transmission to sexual partners and family members , offered keluraga of hepatitis patients to receive specific echoes pure globulin against hepatitis A virus hepatitis B virus , which can provide passive immunity against infection , but temporary . hepatitis B virus vaccine via intramuscular three times at specified interva , one and two doses given one month apart , intravenous dose administered six months after the fifth dose .
1 . understanding Hepatitis
Hepatitis is a diffuse inflammatory process in tissues that can be caused by viral infection and by the toxic reactions to drugs and chemicals . ( Sujono , 1999) .
Acute hepatitis is an acute infectious disease with the main symptom is closely related to the presence of necrosis in the liver ( Mansjoer , 1999) .
Acute viral hepatitis is an infectious disease that is spread widely in the body , although the striking effect occurs in the liver ( Price, 1995) .
Chronic viral hepatitis , is a collection of heart disease due to various causes with more severity than six months ( Batticaca , 2009) .
Hepatitis A or infectious hepatitis is a disease is transmitted through oral contamination - pekal poor hygiene or contaminated food ( Suzanne , 2001) .
2 . Etiology of Hepatitis A
According Batticaca , (2009 ) that cause hepatitis are as follows a) . Virus , hepatitis A virus ( HAV ) was once known as infectious hepatitis with an incubation period ranging from 15-45 days , or three to four weeks , not two nanometer -sized capsule , heat resistant , and acid resistant virus is present in the stool of patients , b ) . Alcohol causes alcoholic hepatitis and alcoholic cirrhosis subsequently became , c ) . Medications causing toxic to the liver , so it is often called toxic hepatitis and acute hepatitis , d ) . Bacterial agents , by physical or chemical injury can cause nonviral hepatitis .
3 . Hepatitis classification
Some viruses are known to menginfersikan hepatitis A , hepatitis B , hepatitis C , hepatitis D , hepatitis E.
1 . Hepatitis A / Hepatitis is an infectious disease transmitted through oral - pekal contamination due to poor hygiene / food contaminated .
2 . Hepatitis B / serum hepatitis is a disease that is serious and is usually transmitted through contact with blood containing the virus . The disease is also transmitted through sexual intercourse and can be found by other body fluids cement .
3 . Hepatitis C / Hepatitis non - A non - B . This virus is a common cause of infection to blood -borne supali commercial . Hepatitis C is transmitted together with hepatitis B mainly through blood transfusion .
4 . Hepatitis D / hepatitis delta and actually is a defective virus that he himself can not infect hipatosit to cause hepatitis . Hepatitis D is transmitted like hepatitis B. Hepatitis D antigen and antibody can be checked on a blood donor .
5 . Hepatitis E was identified in 1990. This virus is a virus that is transmitted through ingestion of contaminated water . Most of the reported cases are found in developing countries .
4 . Pathophysiology and Basic Human Needs Irregularities In Clients With Hepatitis .
Inflammation spreads to the liver ( hepatitis ) can be caused by viral infection and by the toxic reactions to drugs and chemicals . The basic functional unit of the liver is called lobul and this unit is unique because it has its own blood supply . Often with the development of inflammation in the liver , the liver disrupted the normal pattern . Disruption of the normal blood supply to the liver cells causing necrosis and damage to the liver cells . After passing his time , the liver cells become damaged disposed of by the body's immune system response and replaced by a new liver cells healthy . Therefore , most of the clients who have hepatitis recovered with normal liver function is the metabolism of amino acids . Hearts change the amino acid excess into fat , produce hemoglobin which is the basic ingredient of bile , and the change in the absorption of nutrients from the gut , ( Price and Wilson , 1995) .
Inflammation of the liver due to viral invasion would lead to an increase in body temperature and heart 's capsule stretch lead to feelings of discomfort in the upper right quadrant of the abdomen . This is manifested by the presence of nausea and pain in the gut .
Onset of jaundice because the liver parenchymal cell damage . Although the number of billirubin that has not undergone conjugation into the liver remained normal , but due to liver cell damage and intra- hepatic bile duktuli , then there is the difficulty of transporting billirubin in the liver . There was also a difficulty in terms of conjugation . Consequently billirubin imperfect issued through the hepatic duct , due to retention ( due to the excretion of cell damage ) and regurgitation in duktuli , bile has not undergone conjugation ( indirect bilirubin ) , and bilirubin were already experiencing conjugation ( direct bilirubin ) . So here jaundice arising mainly due to difficulties in transport, conjugation and excretion of bilirubin ( price and wilson , 1995 )
Feces contain little sterkobilin therefore , pale stools ( abolis ) . Because the water-soluble bilirubin conjugation , bilirubin can be excreted into the urine , resulting in urine and urinary bilirubin dark . Elevated levels of conjugated bilirubin can be accompanied by an increase in bile salts in the blood that would cause itching and jaundice .
1 . Clinical Manifestations of Hepatitis
Signs and symptoms of hepatitis A viral hepatitis type A hepatitis A outbreak that the child typically cause symptoms in adults when there are symptoms such as fatigue , fever , nausea , abdominal pain , yellow eyes and loss of appetite . The symptoms will disappear altogether in the incubation period of six to twelve weeks . People who have received the hepatitis A outbreak will be immune to the disease . Unlike hepatitis B and C , hepatitis A outbreak led to the enactment of chronic hepatitis .
In general, signs and symptoms of hepatitis according Eltzer & Suzanna , (2001 ) is as follows :
1 . Incubation period , each kind of different hepatitis viruses , A Virus shoots past 15-45 days (average 25 days ) , virus B shoots past 40-180 days ( average 75 days ) , non- A and non Viruses B - tunasnya15 past 150 days (average 50 days ) .
2 . Phase Pre jaundice
Complaints are generally not typical . Complaints caused by a viral infection lasts about two to seven days . Decreased appetite ( first arose ) , nausea, vomiting , upper right abdomen ( solar plexus ) felt ill . The whole body aches , especially in the waist , shoulders and malaise , irritability fatigue , increased body temperature of around 39oC lasts for two to five days , headache , and joint pain .
3 . phase jaundice
Concentrated tea-colored urine , pale stools , decreased body temperature accompanied by bradycardia . Jaundice of the skin and sclera continues to increase in the first week , then settled and the new reduced after 10-14 days . Sometimes accompanied by itching all over the body pasa , lethargy and irritability capeh flavor felt for one to two weeks . Healing phase began when the disappearance of the signs of jaundice , nausea , pain in the pit of the stomach , followed by increased appetite on average 14-15 days after the onset of jaundice , the color looks normal people start to feel fresh again .
2 . examination Support
As for the investigation of patients with hepatitis is as follows
a. laboratory
Liver function tests : abnormal ( 4-10 times normal ) note : a limit value for distinguishing viral and non- viral hepatitis , AST ( SGOT ) ALT ( SGFT ) : initially increased , rising to 102 weeks before jaundice then seemed to decline , complete blood : HR decreased in relation to the decrease in human life ( liver enzyme disorders ) or result in bleeding , Leokopenia : thrombocytopenia may exist ( splenomegah ) , complete blood differentiation : leukocytosis , monositasi , atipikel lymphocytes , and plasma cells , alkaline fostosme complete : leukocytosis , monocytosis somewhat increased ( unless there is a heavy leukstasis ) , feces : color clay , steahorea (decreased liver function ) , serum albumin : decreased , blood sugar , hyperglycemia transfer / hypoglycemia ( impaired liver function ) , Anti- HAV IgM : Positive on type A , HBs AG : Positive DPT ( type B ) or negative ( type A ) note : a diagnostic before clinical symptoms occur , protombin period : may elongate ( liver dysfunction ) , serum Silirobin : above 2.5 mg / 100 ml when above 200 mg / ml of a poor prognosis may be related with an increase in secondary necrosis . Tereksfesi ESP : increased blood levels , liver biopsy : diagnosis and shows the extent of necrosis .
b . Radiology
The radiological examination in patients with hepatitis A is is as follows a) . X-ray examination of the abdomen , b ) . Displacement careful with technetium preparations , gold , or rose bengal labeled radioactive , c ) . Kolestogram , d ) . Kalangiogram , and e ) . Celiac arteriography blood vessels .
c . additional examination
Additional examination in the case of hepatitis is laparoscopy and liver biopsy .
3 . management
Treatment of viral hepatitis is primarily suporsif and include : Rest as needed , health education regarding avoiding use of alcohol / drugs , health education about the modes of transmission to sexual partners and family members , offered keluraga of hepatitis patients to receive specific echoes pure globulin against hepatitis A virus hepatitis B virus , which can provide passive immunity against infection , but temporary . hepatitis B virus vaccine via intramuscular three times at specified interva , one and two doses given one month apart , intravenous dose administered six months after the fifth dose .
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