Hepatitis C disease

Hepatitis C disease

Introduction

Hepatitis C disease causes human liver infection and inflammation. The condition occurs after an individual is affected by the Hepatitis C virus (HCV).  The disease is highly contagious, and a huge number of people have the disease. The condition can be serious and lead to either liver cancer or liver disease if not treated appropriately. Hepatitis C is found in the entire world. There are about 71 million people chronically infected with hepatitis C globally, wherein 2013, an estimate of 400,000 died with liver disease. The disease prevalence varies across the world and various regions. Most developed countries have a 4-05 prevalence while it is higher in some Eastern European countries like Russia 2.2%, some African countries like Egypt 7.7% ad the Middle East like Syria 3.0%. In the United States, there are more than 3.5 million who have chronic hepatitis C (DNDi, 2018).

Even though hepatitis C is found anywhere in the globe, which makes an interesting heath study topic, it has six dissimilar HPV genotypes distributed across the world. GT1 is common in developed countries (high-income countries), while GT3 is common in undeveloped and developed countries (both low- and middle-income nations). GT3 accounts for thirty percent of world hepatitis C infection. HPV is widely distributed to the general population in countries with inadequate infection control practices. This paper will discuss the population with risk for hepatitis C, the disease process pathophysiology, its signs, symptoms, and diagnosis, examples of nursing diagnosis, medical interventions at three levels, and sequelae.

Population with risk for Hepatitis C

HPV is commonly spread through contact with infected blood and its products. The population with a high risk for contracting hepatitis C include:

• New-borns to HIV infected mother- The virus does not infect infants during developmental stages in mother womb. However, pregnant mothers can pass HCV during the birth process. The risk takes place during the birth process; the newborn likely gets into contact with the infected blood when there is not any prevention prophylaxis. The risk factor considerably high when a pregnant person has a huge viral load.
• Injection drug users- intravenous usage of drugs is a worldwide hepatitis C risk factor.

Injections. Infection occurs when a drug user shares a needle with an infected person, thus passing the virus (van Vlymen et al., 2019).

• Health care workers – Health care workers have a high risk of contracting hepatitis C compared to the general public. In the health care setting, workers who directly work with blood, blood products, or organ transplant are likely to experience needle stick accidents. Hepatitis C is commonly spread through contact with blood and blood products from infected patients. Blood contact, like due to needle stick injuries, is a risk factor to the health care setting workers. It is not easy to fully avoid contact with blood even by using preventive instruments. Thus, blood infection risk is common to health care workers. Male health care workers have more risk factors for contracting hepatitis C than females.
• Individuals who had blood and blood product transfusions and organ donations before June 1992. Before 19992, there were no tests sensitive for testing HCV; thus, any individual who had transfusion during that time have a high risk.

Populations with slight but increased risk for hepatitis C include:

• Individuals with risky sexual behaviour, STIs, and multiple partners- hepatitis is not commonly transmitted sexually. However, unhealthy sexual behaviours, like having multiple partners increase the risk factor for HCV. s
• People sharing personal effects like razors and toothbrushes, among others, with infected individuals. The personal item can be contaminated with blood. Sharing personal items with an infected person increases exposure to the virus (Hepatitis C Online, 2020).

Pathophysiology of hepatitis C disease process

Hepatitis C is caused by the HCV virus and leads to human liver inflammation. Globally, HCV infects about 170 million people. HCV virus is non-cytopathic and enters the liver cells to undergo simultaneous replication resulting in cell necrosis.  HCV virus is spread by direct contact with infected blood and blood products.  It occurs through mechanisms like immune-mediated cytosis, oxidative stress, insulin resistance, and hepatic steatosis. Hepatitis C viral incubation period is about eight weeks. The HCV lifecycle is not understood clearly due to the absence of a productive cell structural system. HCV entry mechanism is not unknown, but several molecules are drawn in the receptor complex. Persistent HCV infection occurs as a result of frail CD4+ as well as CD8+ T- cells that are not able to prevent Acute HCV infection follows a mild course even if it is symptomatic.  Acute HCV aminotransferase tends to be hardly greater than 1000 U/L level.

An estimation of 15% to 45% of acutely infected patients loses HCV virologic markers. As a result, newly infected people can have the chronic liver disease since they are viremic. Fatigue is the main symptom of chronic hepatitis C infection. Hepatitis C symptoms are not associated with aminotransferase levels. Also, levels of aminotransferase range from 40U/L reference values to 300U/L values (Hepatitis C Online, 2020). Some chronic hepatitis C patients experience liver cirrhosis. However, it takes more than ten years for hepatitis C to progress to liver cirrhosis. It is important to offer nursing counselling to patients who are newly diagnosed with liver cirrhosis on liver failure risk. There are a few patients who are expected to decompensate after ten years of follow up after being diagnosed with liver cirrhosis. Individuals suffering induced HCV cirrhosis to have a high likelihood of developing HCC, particularly when in the HBV coinfection setting. HCC in the United States occurs in less than 5% of patients suffering induced HCV cirrhosis every year. Therefore, patients with induced HCV cirrhosis has to be screened regularly to avert HCC development. Furthermore, 20000 yearly deaths are caused by HCV underlying factors.

Signs, symptoms and diagnostic procedures (assessment)

Signs and symptoms

Hepatitis C acute infection results in chronic infection after several years if not treated appropriately. Acute infection symptoms include fatigue, nausea, jaundice, poor appetite, low-grade fever that lasts for 2 – 10 days, and upper right-side abdominal pain.

Chronic infection: For chronic patient liver functions normally, but it is slightly affected in some individuals despite the inflammation. The liver develops fibrosis when it is affected for a long period, which results in cirrhosis. Chronic infection symptoms are not notifiable in some individuals, while others experience significant impacts.  An individual suffering from chronic hepatitis C may experience a variety of symptoms. These symptoms include muscle aches, fine body rash, discomfort in the upper right abdominal side, malaise, and nausea. These symptoms can disappear for a long duration of time, then reappear again (CDC, 2019).

diagnostic procedures

symptoms do not present a doctor with adequate evidence about hepatitis C.  Few people are diagnosed early because HCV infections are asymptomatic until decades when symptoms develop secondary to adverse liver damage. HCV is diagnosed with the following steps:

• Anti HCV antibodies testing by use of a serological test to identify the individual with the virus.
• If anti HCV antibodies test is positive, a nucleic test for HCV RNA (ribonucleic acid) is used to confirm the presence of chronic infection. This is because an estimate of 30% of individuals with HCV clears the infection by a strong immune system with the absence of treatment. Such people test positive although they are not infected.

Other diagnoses tests used when there are abnormal results are ultrasound and liver biopsy. Abdominal ultrasound applies waves to generate an image of internal abdominal organs. The test enables a doctor to observe the liver and other abdominal organs closely. Ultrasound test discloses liver tumours, gallbladder abnormalities, and liver inflammation as well as damage. The liver biopsy test procedure encompasses a sampling of liver tissue by a doctor. It enables a doctor to identify the extent of liver damage by infection.

Nursing diagnoses

Here are two examples of hepatitis C nursing diagnoses are fatigue and imbalanced, less than body requirements.

Fatigue

Fatigue is a devastating exhaustion sense and a decline in levels of mental and physical levels. It may be related to discomfort states, the decline in production of metabolic energy, and body chemistry alteration. It is evidenced by decreased performance, physical complaints increment, and energy loss or failure to maintain usual routines. The desired outcomes are an improved sense of energy and performing ADLs as well as participating in desired events.

Imbalanced nutrition

Intake of inadequate nutrient to meet body metabolic requirements. It is related to alteration of ingested food materials absorption and metabolism (reduction of peristalsis and bile stasis), the increment of calorie demands, and inadequate intake of metabolic demands (vomiting and anorexia). Imbalanced nutrition is evidenced by abdominal pains, weight loss, and eating aversion. Desired outcomes are lifestyle changes to sustain appropriate weight and demonstration of progressive weight improvement with not malnutrition signs.

Treatment

New HCV infection does not always necessitate treatment because the immune system can respond to clear the infection. Treatment is vital when HCV infection becomes chronic, and it aims at providing a cure. Treatment methods include antiviral medications, liver transplantation, and vaccinations (Mayoclinic, 2019).

The infection is treated by use antiviral medications that aim at getting rid of HCV from the body. Treatment aims at detecting no hepatitis C virus at 12 following good completion of medication. There has been recent innovation in the treatment process by using new as well as direct-acting antiviral medications. Some of the common and currently available direct-acting drugs are simeprevir (Olysio), paritaprevir or ritonavir, ledipasvir, ombitasvir, daclatasvir (Daklinza), sofosbuvir (Sovaldi), and dasabuvir. The side effects of direct-acting antiviral drugs are nausea, headache, fatigue, depression, weakness, muscle spasms, and dizziness. Therefore, the common forms of chronic hepatitis are cured due to new antiviral drugs.

Liver transplant is a treatment alternative when chronic hepatitis C has developed serious complications. The surgeon gets rid of the damaged liver and implants a healthy one. Livers are obtained from either deceased donors or living donors. Liver transplant does not provide a cure at all times; thus antiviral treatment is required. There are no hepatitis C vaccines, but doctors may recommend vaccination against hepatitis A and B viruses. These viruses can damage the liver and complicate chronic hepatitis C.

Prevention

Acute and chronic diseases are the major causes of death in developed countries. In the United States, the diseases account for huge health care expenditure in offering primary, specialty, and acute care. There are variations in treatment, diagnosis, transmission, and geographic distribution of hepatitis C. Therefore, to hepatitis C prevention and control strategies are required at primary secondary, and tertiary levels (CDC, 2019). Hepatitis C prevention efforts addressed both acute and chronic patient conditions.

Primary prevention

The objective of primary prevention is to avoid the development of hepatitis C disease. It entails identification and addressing behaviour as well as conditions that cause viral hepatitis C. primary prevention efforts are geared toward adjustable factors through promoting healthy behaviours, early screening, prevention of specific disease, and creating healthy environments. Currently, there is no vaccine for hepatitis C, unlike hepatitis A and B, to prevent HCV. As a result, HCV infection is prevented through the reduction of risks associated with exposure to the virus in risky populations as well as health care settings. Some of the primary prevention mechanisms are;

• Using health care injections appropriately and safely
• Safe management and disposal of hospital waste
• Training health care appropriately on prevention mechanisms
• Screening presence of HCV and other viruses in donated blood
• Reduction of exposure to blood during sexual intercourse through the appropriate use of condoms
• Maintenance of hand hygiene, use of gloves, hand washing, and surgical preparation.

Secondary prevention

It aims at detecting hepatitis disease as at the early stages to prevent its progression and subsequent symptoms development. Early detection promotes timely treatment to avoid disease progression and related complications. Furthermore, early detection of hepatitis C prevents its spreading to family, colleagues at work, and the general public. The following are some preventive measures for people infected with hepatitis C virus adapted from the World Health Organization (WHO);

• Counselling and educating patients on the importance of acquiring treatment
• HCV early diagnoses and regular monitoring for chronic liver disease
• Appropriate and early medical management, for example, antiviral therapy
• Use of hepatitis A and B vaccinations to avoid hepatitis virus’s coinfection thus protecting the liver

Tertiary prevention

It focuses on people with chronic hepatitis C by paying attention to effective treatment and averting disease progression, disabilities, and complications. Tertiary prevention concentrates on managing behaviours that lead to worsened conditions. Public health workers implement the efforts because it involves authentic treatment and care. Patients are counselled appropriately to change their behaviours and minimize the spread of hepatitis C, thus reducing health care costs. Some primary prevention efforts, like those focusing on a healthy diet, immunizations, and physical activities, are important in managing chronic patients.

Sequelae

Hepatitis C leads to serious secondary health complications if not treated on time. The HCV virus affects a chronic patient liver and results in chronic liver disease, liver cancer, and liver cirrhosis. Moreover, liver failure can likely occur when the infection prevents normal liver functioning (World Health  Organization, 2018). Complications originating from liver failure are bleeding disorders, ascites, portal hypertension, kidney failure, hepatocellular carcinoma, hepatic encephalopathy, and even death.

conclusion

HCV virus is spread through blood contamination like by sharing needles and unsterilized tattoo equipment with infected people, among others. It can be acute or chronic and lacks vaccination, unlike hepatitis A and B. Acute hepatitis C takes place within six months after contaminating the HPV. The condition can be a short-term illness, although, for most patients, acute infection results in chronic infection. Chronic hepatitis C can be a lifetime infection not treated accordingly. Chronic hepatitis C tends to lead to serious health problems like damage to the liver, liver cancer, liver cirrhosis, and death at times. Finally, hepatitis C learning has equipped me with knowledge of diagnosis, treatment, and prevention in the nursing practise.

References

CDC. (2019a). Hepatitis C Questions and Answers for the Public. https://www.cdc.gov/hepatitis/hcv/cfaq.htm

CDC. (2019b). Recommendations for Prevention and Control of Hepatitis C Virus  (HCV) Infection and HCV-Related Chronic Disease. https://www.cdc.gov/mmwr/preview/mmwrhtml/00055154.htm

DNDi. (2018). About Hepatitis C – DNDi. Www.Dndi.Org. https://www.dndi.org/diseases-projects/hepc/

Hepatitis C Online. (n.d.). HCV Epidemiology in the United States HCV Incidence in the United States Definitions of HCV Incidence. Retrieved March 8, 2020, from https://www.hepatitisc.uw.edu/pdf/screening-diagnosis/epidemiology-us/core-concept/all

Mayoclinic. (2019). Hepatitis C – Diagnosis and treatment – Mayo Clinic. Mayoclinic.Org. https://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/drc-20354284

van Vlymen, J. M., Magnus, J., Jaeger, M., Breton, S., Taylor, N. G., Phelan, R., & Sagan, S. M. (2019). Hepatitis C Contamination of Medication Vials Accessed with Sterile Needles and Syringes. Anesthesiology, 131(2), 305–314. https://doi.org/10.1097/aln.0000000000002772

World Health  Organization. (2018, July 18). Hepatitis C. Who.Int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c