a. Causes widespread damage to liver cells (hepatocytes) either
directly or indirectly from inflammation or autoimmune
b. May be acute or chronic
i. Acute: Swelling of hepatocytes reduces ability to detoxify
drugs; produce clotting factors, plasma proteins, bile, and
glycogen; and store fat-soluble vitamins.
ii. Chronic: inflammation and necrosis of liver of more than
6 months’ duration
a. Infectious causes: viral, bacterial, fungal, or parasitic
i. Viruses are designated by letters A through G, with several
terms used interchangeably, for example, hepatitis B is
known as HBV or HepB; types A through D are endemic
in the United States and transmitted by blood and other
body fluids, sexual or close contact with infected person,
and fecal contamination of food and water.
ii. Other viruses: cytomegalovirus (CMV), Epstein-Barr virus
(EBV), Mycobacterium avium complex (MAC), herpes
simplex, varicella-zoster, toxoplasmosis, and histoplasmosis
b. Noninfectious causes: physical or toxic chemical agents,
i. Toxic agents: carbon tetrachloride, vinyl chloride; alcohol,
cocaine, acetaminophen, isoniazid, anabolic steroids,
methyldopa, erythromycin; poisonous mushrooms
ii. Autoimmune: no identifiable etiology; two types, with
type 1 most common form in North America
a. Morbidity: HAV, HBV, and HCV cause more than 90%
of cases of acute viral hepatitis in the United States
(Buggs & Kim, 2006).
i. The Centers for Disease Control and Prevention (CDC)
reported 7,653 acute clinical cases of HAV in 2003, with
the estimate of actual clinical cases at 33,000 and
estimated number of new infections in the United States
at 61,000 (Gilroy & Mukherjee, 2006).
ii. About 1.25 million people are chronic HBV carriers,
and the disease causes about 5,000 deaths each year
(Mukherjee, 2005); 22,000 pregnant women in the
United States are infected with HBV and can transmit
the virus to their newborns.
iii. HCV is a leading cause of chronic hepatitis and cirrhosis
worldwide; studies have shown that almost 30% of
persons with human immunodeficiency virus (HIV)
infection also have hepatitis (Baker, 2007).
b. Mortality: Approximately 100 Americans die from HAV,
and another 5,000 die from cirrhosis and 1,000 from liver
cancer due to HBV infections (Buggs & Kim, 2006);
chronic liver disease associated with persistent hepatitis
virus infection accounts for an estimated 16,000 deaths
per year—70% from HCV, 20% from HBV, and 10% from
combined infection with HCV and HBV (Gilroy &
Mukherjee, 2006); fatality rate for hepatits E is 4%
(Schwartz et al, 2006).
c. Cost: Annual cost associated with HAV is estimated at
$200 million in the United States (Hepatitis Foundation
International [HFI], 2003).
Care can frequently be provided in the outpatient setting or
at the community level. In states of acute hepatic inflammation,
brief inpatient acute care on a medical unit may be
required to monitor and treat hepatic failure or hepatic
Alcohol: acute withdrawal,
Cirrhosis of the liver,
Psychosocial aspects of care,
Renal dialysis—general considerations,
Substance dependence/abuse rehabilitation,
Total nutritional support: parenteral/enteral feeding,
1. Reduce demands on liver while promoting physical wellbeing.
2. Prevent complications.
3. Enhance self-concept and acceptance of situation.
4. Provide information about disease process, prognosis, and
1. Basic self-care needs are met.
2. Complications prevented or minimized.
3. Dealing with reality of current situation.
4. Disease process, prognosis, transmission, and therapeutic
5. Plan in place to meet needs after discharge.