Johnson County Health Department Amber Terhune, BSN, RN, Health Educator October 2019 Liver Inflammation

 Liver function:  Process nutrients  Filter blood  Fight infections

 Most common types in US:  Hepatitis A  Hepatitis B  Hepatitis C

Crasto, Dr. Anthony Melvin. World Hepatitis Day- European Medicines Agency Uses Regulatory Tools to Facilitate Patient Access to Innovative Medicines, 9 Aug. 2014. https://amcrasto.wordpress.com/2014/08/09/world-hepatitis-day-european-medicines- agency-uses-regulatory-tools-to-facilitate-patient-access-to-innovative-medicines/

2 3 Contagious Liver Infection

 Caused by Hepatitis A virus

 Hepatitis A = HAV

 Range from mild to severe

 Does not become chronic

Mandal, Dr. Ananya. News Medical. Hepatitis A Outbreak Among Population of San Diego, 3 Sep. 2017. https://www.news-medical.net/news/20170903/Hepatitis- A-outbreak-among-population-of-San-Diego.aspx

4 Some Cases Undiagnosed and Unreported

CDC. Hepatitis A Questions and Answers for Health Professionals, 10 Sep. 2019. https://www.cdc.gov/hepatitis/hav/havfaq.htm

5 Person to Person

 Fecal-oral route

 Virus can live outside body for months

Upper Peninsula Health Plan. Protect Yourself from Hepatitis A, 3 Apr. 2018. https://www.uphp.com/blog/2018/04/03/protect-yourself-from-hepatitis-a/

6 Some Have None

 Incubation average 28-30 days

 Infectious 2 weeks before to 2 weeks after symptoms

Indiana State Department of Health. Indiana Hepatitis A Outbreak, 15 Jan. 2019. https://www.in.gov/isdh/27791.htm

7 Combination of Methods

 Physical exam

 Symptoms

 Blood tests

Findlay, J. Health Prep. 8 Important Facts About Hepatitis A; Symptoms, Treatment and More, n.d. https://healthprep.com/conditions/8- important-facts-about-hepatitis-a-you-need-to-know/

8 None: Treat Symptoms

 Avoid medications without doctor’s approval

 Medical follow-up

 Most recover within 2 months

Litza, MD, Janice. WikiHow. How to Treat Hepatitis A, 27 May 2019. https://www.wikihow.com/Treat-Hepatitis-A

9 Unvaccinated

Close Contact Illicit Drug Incarceration of HAV + Use Individual

Men Who International Homelessness Have Sex With Travel Men

10 More Likely in Some Populations

 May need hospitalization  Death rare but possible

Lupkin, Sydney. ABC News. California Woman Sues Costco, Berry Farm Over Hepatitis A, 5 Jun. 2013. https://abcnews.go.com/Health/woman- sues-costco-berry-farm-hepatitis/story?id=19331847 11 Symptomatic

 Exposed or think exposed  Worsening symptoms

Litza, MD, Janice. WikiHow. How to Treat Hepatitis A, 27 May 2019. https://www.wikihow.com/Treat-Hepatitis-A

12 Avoid Spreading to Others

 Take precautions when traveling

Illinois Department of Public Health. Hepatitis A, n.d. http://www.dph.illinois.gov/hepatitisA#Am I at risk for getting hepatitis A? 13 14 Contagious Liver Infection

 Caused by Hepatitis B virus

 Hepatitis B = HBV

 Acute or Chronic

Pinterest. Hepatitis B Facts, 2013. https://www.pinterest.com/pin/276338127112973675/

15 About 850,000 – 2.2 Million Chronic Infections

CDC. Hepatitis B Questions and Answers for Health Professionals, 8 Oct. 2019. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm

16 Virus Can Live Outside Body for at Least 7 Days

Immunization Info. Hepatitis B Vaccine, n.d. https://www.immunizationinfo.com/hepatitis-b/ 17 Some Have None

 Symptoms appear 60-150 days after exposure

Flamm, MD, Steven L. Liberate Health. Hepatitis B, Mar. 2014. http://liberatehealth.us/liberate_condition/hepatitis/hepatitis-b-condition-full-deck/ 18 Combination of Methods

 Physical exam  Symptoms

 History  Testing

Matsko, MD, Chris M. How to Diagnose Viral Hepatitis, 26 Mar. 2019. https://www.wikihow.com/Diagnose-Viral-Hepatitis

19 No Cure

 Some clear virus naturally

 Different based on acute vs. chronic infection

Windham, MD, Lacy. How to Treat Hepatitis B, 18 Apr. 2019. https://www.wikihow.com/Treat-Hepatitis-B 20 Unvaccinated

Flamm, MD, Steven L. Liberate Health. Hepatitis B, Mar. 2014. http://liberatehealth.us/liberate_condition/hepatitis/hepatitis-b-condition-full-deck/ 21 Death is Possible

Jayalakshmi, MariaKuttikan et. al. Hepatitis B Virus Genetic Diversity: Disease Pathogenesis, 27 Feb. 2013. https://www.intechopen.com/books/viral-replication/hepatitis-b-virus-genetic-diversity-disease-pathogenesis 22 If You Want Tested

 Symptomatic

 At risk for HBV

 Exposed to HBV

 Already diagnosed

Windham, MD, Lacy. WikiHow. How to Treat Hepatitis B, 18 Apr. 2019. https://www.wikihow.com/Treat-Hepatitis-B 23 Universal Precautions

Matsko, MD, Chris M. WikiHow. How to Prevent Hepatitis B, 4 May 2019. https://www.wikihow.health/Prevent- Hepatitis-B

24 Routine Physician Care

Windham, MD, Lacy. WikiHow. How to Treat Hepatitis B, 18 Apr. 2019. https://www.wikihow.com/Treat-Hepatitis-B 25 26 Contagious Liver Infection

 Caused by Hepatitis C virus

 Hepatitis C = HCV

 Acute or Chronic

Hepatitis C GIDS. What is Hepatitis C, n.d. https://www.hepatitiscgids.nl/en/what-is-hepatitis-c/symptoms 27 Most Common Blood-Borne Disease

CDC. Surveillance for Viral Hepatitis-United States, 2017, 10 Sep. 2019. https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm

28 Direct Contact with Blood or Body Fluids

Yes!

Tacoma-Pierce County Health Department. Hepatitis C, n.d. https://www.tpchd.org/healthy-people/diseases/hepatitis/hepatitis-c

No!

Surcation. Survivor’s Vacation, n.d. http://www.surcation.com/hepc-spreads/ 29 No Symptoms in About 80% of Those Infected

 Symptoms appear 2-12 weeks after exposure

Peterson, Samuel. STD+. Hepatitis C, 8 Jun. 2017. https://www.std-gov.org/stds/hepatitis_c.htm 30 Physical Exam and History

Daniel, Charles. Very Well Health. How Hepatitis C Virus is Diagnosed, 20 Sep. 2019. https://www.verywellhealth.com/hepatitis-c-diagnosis-1759914 Spach, MD, David H. Hepatitis C Diagnostic Testing, 12 Apr. 2018. https://www.hepatitisc.uw.edu/go/screening-diagnosis/diagnostic-testing/core-concept/all 31 15-25% Clear Virus Naturally

 Goal: No detectable hepatitis C virus

Midway Specialty Care Center. Treating Hepatitis C, n.d. https://www.midwaycare.org/information/treating-hepatitis-c/ 32 Live With/Care for HCV + Person

 Long-term hemodialysis

 HIV infection

 Ever been in prison

 Born between 1945-1965

Public Health Agency of Canada. Hepatitis C: Are You at Risk? 17 Jul. 2017. https://www.canada.ca/en/public-health/services/publications/diseases- conditions/poster-hepatitis-c-are-you-at-risk.html 33 Can Be Fatal

Thornton, MD, MPH, Karla. Hepatitis C Online. Natural History of Hepatitis C Infection, 31 May 2018. https://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/natural-history/core-concept/all

34 If You Want Tested

 Symptomatic

 At risk for HCV

 Exposed to HCV

 Already diagnosed

Ziats, MD, PhD, Mark. WikiHow. How to Get Treatment for Hepatitis C, 24 Jul. 2019. https://www.wikihow.com/Get-Treatment-for-Hepatitis-C

35 Universal Precautions

Smith, MD, Tawana. WikiHow. How to Recognize Hepatitis C Symptoms, 23 May 2019. https://www.wikihow.com/Recognize-Hepatitis-C-Symptoms 36 Routine Physician Care

 Caution with medications

 Follow healthy lifestyle

 Follow treatment plan

 Prevent spread to others

 Get support

Milk Thistle. Help Prevent and Treat Liver Disease with Milk Thistle, n.d. https://www.milkthistle.com/health-benefits/milk-thistle-liver-cleanse 37 Centers for Disease Control and Prevention. “Viral Hepatitis.” CDC.gov, 13 Jun. 2019. https://www.cdc.gov/hepatitis/index.htm. Accessed 11 Jul. 2019. Felson, MD, Sabrina. “Hepatitis B.” WebMD.com, 14 Nov. 2018. https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b#1. Accessed 11 Jul. 2019. Indiana State Department of Health. “Hepatitis B.” ISDH.IN.gov, 29 Jun. 2018. https://www.in.gov/isdh/25477.htm. Accessed 11 Jul. 2019. Indiana State Department of Health. “Indiana Hepatitis A Outbreak.” ISDH.IN.gov, 15 Jan. 2019. https://www.in.gov/isdh/27791.htm. Accessed 15 Jul. 2019. Indiana State Department of Health. “Hepatitis C.” ISDH.IN.gov, 1 May 2018. https://www.in.gov/isdh/25474.htm. Accessed 20 Nov. 2018. Mayo Clinic. “Hepatitis A.” MayoClinic.org, 6 Mar. 2019. https://www.mayoclinic.org/diseases-conditions/hepatitis-a/symptoms-causes/syc- 20367007. Accessed 11 Jul. 2019. Mayo Clinic. “Hepatitis B.” MayoClinic.org, 27 Oct. 2017. https://www.mayoclinic.org/diseases-conditions/hepatitis-b/symptoms-causes/syc- 20366802. Accessed 11 Jul. 2019. Mayo Clinic. “Hepatitis C.” MayoClinic.org, 6 Mar. 2018. https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc- 20354278. Accessed 20 Nov. 2018. National Institute of Diabetes and Digestive and Kidney Diseases. “Hepatitis A.” NIDDK.NIH.gov, May 2017. https://www.niddk.nih.gov/health- information/liver-disease/viral-hepatitis/hepatitis-a. Accessed 11 Jul. 2019. National Institute of Diabetes and Digestive and Kidney Diseases. “Hepatitis B.” NIDDK.NIH.gov, May 2017. https://www.niddk.nih.gov/health- information/liver-disease/viral-hepatitis/hepatitis-b. Accessed 11 Jul. 2019. Robinson, Jennifer. “Hepatitis C and the Hep C Virus.” WebMD.com, 2 Dec. 2018. https://www.webmd.com/hepatitis/digestive-diseases-hepatitis- c#1. Accessed 20 Nov. 2018. Teen Source. “Hepatitis B.” TeenSource.org, n.d. https://www.teensource.org/std/hepatitis-b. Accessed 11 Jul. 2019.

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