Chronic Active Hepatitis - Research Paper Example

Chronic active hepatitis is the most common type of chronic hepatitis. This disease develops over a long time and it might progress to otherforms of hepatitis and liver complications. This paper looks at the causes and symptoms that are commonly associated with this disease. Risk factors have also been covered in depth. Different diagnostic processes as well as treatment options are discussed in the paper. Patient and family education, psychosocial issues as well as implications for public health are some of the important issues that have also been discussed in this paper. The importance of patient and family education is important in ensuring that the patient recovers in a friendly environment. Psychosocial issues that the patients have to endure include stigmatization from the general public as well as bouts of anxiety and depression. The paper also covers how patients should be referred to specialties when they discover that they have contacted chronic active hepatitis so as to get the best treatment. Chronic Active Hepatitis Hepatitis is a kind of liver inflammation. This inflammation can be caused by toxins, viruses and auto-immune disorders. Chronic active hepatitis is a common form of chronic hepatitis that can persist to hepatic cirrhosis or primary liver cancer. Inflammation to the liver is normally caused by necrosis of hepatocytes due to lymphocyte infiltration and lymphatic portal reaction. It is one of the diseases that is hard to diagnose during its initial stages due to its lack of symptoms (Cohen, Doner & Gish, 2007). Some of the symptoms and signs that are likely to occur in the advanced stage include upper abdominal discomfort or pain, asthenia, anorexic tendencies, weight loss, itching and joint aches (Wrong Diagnosis, 2010). Clinical signs for this infection are: hepatomegaly, palmar erythema, spider nevi, enlarged, palpable spleen, fever, ecchymosis, cirrhosis, jaundice, liver failure and ascites (Hepatitis, 2010). Some parts of the body that might be affected by this illness include the thyroid gland, eyes, kidney, blood vessels, joints and lungs. Risk Factors The primary risk factor for chronic active hepatitis is exposure to infected blood. This means that those individuals who use intravenous drugs are at a high risk of being infected with this disease according to Shetty and Wu (2009). Those people who practice high risk sexual-related activities are also among those at a high risk of infection. Health workers who normally deal with blood are the other group of people who are a risk of contacting chronic active hepatitis. Women who take excessive alcohol are also at risk of getting this disease. However, infection through blood transfusion is very rare due to the measures taken before any individual gets a transfusion (Oettinger, Brunnberg and Gerner, 2005). Diagnostic Processes In most cases, there are normally no symptoms reported during the initial stages of the infection. Some people may report some mild symptoms such as loss of appetite, fatigue and nausea, malaise, headaches, joint pain, chest pain, low-grade fever as well as tenderness on the abdominal area (Krawitt, 2006). Some physical examination on the patient may also reveal dry mouth and eyes, an enlarged spleen and liver. Where hepatitis is suspected, the doctor may carry out some blood tests that are meant to measure for the presence of some specific liver enzymes which are normally released after liver inflammation of damage. The blood test is also done to look for bile duct enzymes, bilirubin levels as well as protein levels. Clotting tests are also included so as to evaluate the level of liver functionalities. Immunoassay blood tests are normally carried out to determine the presence and level of some of the key enzymes such as GGT, ALT, AST and EIA. These tests are also used to measure the level of red blood cells, viral antibodies as well as the mean corpuscle volume (Oettinger, Brunnberg and Gerner, 2005). Differential diagnoses According to Sukerek and El-Baba (2010), the different causes of autoimmune hepatitis should be considered during differential diagnoses. Some of the causes emphasized by the Sukerek and El-Baba include Wilson Disease, a 1-antitrypsin deficiency, hepatotoxic drugs, viral hepatitis and excessive alcohol consumption. The laboratory findings for differential diagnoses of chronic active hepatitis include increased levels of serum amonitransferase and immunoglobulin G(IgG) (Protzer & Weber, 2008). The antinuclear, smooth muscle antibodies and/ or liver-kidney microsomal type 1 antibodies also normally show seropositive results. Patients with inflammatory activity may also test positive for antiasialoglycoprotein receptor antibodies. Abnormal results that include low albumin levels and elongated prothrombin time may occur on 50% of patients. Testing liver biopsy specimens is very important in the diagnosis of chronic active hepatitis. The histophathologic findings on these specimens are normally used to help determine the level of severity of this disease (Sukerek and El-Baba, 2010). Treatment Treatment for chronic active hepatitis includes hospitalization, general supportive care and the administration of anti-inflammatory drugs. Some of the anti-inflammatory drugs that are normally administered include riboflavin, lamivudine and interferon. Nutritional supplements are also part of the treatment for chronic active hepatitis. These supplements are normally given due to the fact that there is suppressed protein breakdown in the liver and dehydration in the body. Corticosteroid type of treatment is recommended for those patients whose chronic active hepatitis is not caused by an infection. The drugs administered for this illness are normally taken for up to one year after the disappearance of symptoms. The treatment may require a surgical procedure to transplant the liver. However, this is normally a last resort if the other treatment fails. Patient and Family Education Some of the medicolegal pitfalls that normally occur in the treatment of chronic active hepatitis include the lack of clear explanation to the family about the seriousness of this disease and the lack of emphasis on the importance of follow-up checkups. Another common medicolegal problem occurs when the disease is not diagnosed during its early stage (Sukerek and El-Baba, 2010). To avoid any unnecessary complications, there is need for adequate patient and family education. It is important to educate the family on the need to protect themselves from contacting the same disease. However, they should not be made to feel like they have to avoid the patient who needs as much care and support as he can get from his family. The patient should be encouraged to take care of himself by eating the right kind of foods and avoid any activities that may worsen the situation. This kind of patient and family education is useful in ensuring that the patient does not suffer from some of the psychosocial issues that are normally associated with the diagnosis of chronic active hepatitis. Activities that the patient should be advised to keep away from include alcohol consumption and high risk sexual activities. The patient should also be advised to keep away from any medications that may contain Tylenol. Implications for public health The risk factors, diagnosis, treatment and prognosis for chronic active hepatitis carry great implications for public health. Some of the common risk factors of this disease include excessive alcohol intake, high-risk sexual activities. Anyone who is normally exposed to blood is also at a risk of getting this disease. This means that individuals who work in the public health sector have their work cut out for them. They have to ensure that people in the communities where they work know more about hepatitis and these risk factors. There is need to create awareness about the dangers that come with excessive alcohol intake and engaging in high risk sexual activities (Patient, 2010). It is up to the public health workers to ensure that patients who are suffering from chronic active hepatitis understand what their role is in ensuring that they get the right kind of treatment (Oettinger, Brunnberg and Gerner, 2005). Both the physicians and nurses have a duty of ensuring that patients with this disease have access to the medical requirements they need for and during the entire treatment period. The caregivers should let the patient know the importance of regular checkups as a way of ensuring that nothing goes wrong during the treatment period. Another implication for the public health sector is the need to come up with a type of treatment for the disease which will not require too much medication. The current treatment is not as effective since there is a high number of patients who normally succumb to the disease. More effort should be placed on the research for a more effective antibacterial or antiviral treatment. Psychosocial issues Chronic active hepatitis has a significantly huge impact in the patient and society as a whole. The disease is one of the leading causes of liver transplants in the US (NDDIC, 2006). It can also lead to cirrhosis of the liver, hepatocicellular carcinoma and even death. A lot of patients have to leave their jobs when they have been diagnosed with this disease and this greatly affects the work economy. Medication for illness is also quite expensive and this only adds to the problems it causes. Patients who have been diagnosed with chronic active hepatitis normally a low health-related life quality (HQOL). Many of these patients normally suffer from high levels of depression and anxiety according to the University of Texas Health Science Center (2009). Chronic active hepatitis patients also go through a number of stigmatizing experiences from members of society. This stigma is normally due to a misconception that people have about the disease being caused by irresponsible behavior such as drug use, alcoholism and uncontrolled sexual activites (Krawitt, 2006). Treatment for the disease may also contribute to cases of anxiety, depression and occasional irritability (Chalasani, Faught, Lim, & Molleston, 2006). Since patients and members of the general usually do not know how to deal with this illness, there have been efforts in the public health sector to try and change the existing attitudes towards the illness so as to aid in the patients’ recovery. Chronic active hepatitis patients can be referred to a number of hepatitis specialists from whom they can get specialized treatment. Some of the common specialists who can help these patients include hepatologists and gastroentologists. Any patient who tests positive for any kind of hepatitis should be referred to a specialist for further treatment (Krawitt, 2006). References Chalasani NP, Faught PR, Lim JR, & Molleston JP (2006). "Severe liver injury after initiating therapy with atomoxetine in two children". Journal of Pediatrics, 148 (6): 831–4. Cohen M., Doner K. & Gish R. (2007) The Hepatitis C Help Book: A Groundbreaking Treatment Program Combining Western and Eastern Medicine for Maximum Wellness and Healing (Illustrated ed.) St. Martins Press. Hepatitis (2010) Hepatitis A-Z, retrieved 21st September, 2010 http://www.hepatitis.org.uk/s-crina/whatis-fs.htm NDDIC (2006) Chronic Hepatitis C: Current Disease Management, , retrieved 21st September, 2010 http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/ Oettinger, R., Brunnberg, A., Gerner, P. 2005. Clinical features and biochemical data of Caucasian children at diagnosis of autoimmune hepatitis. Autoimmun, Vol. 24(1) 79-84.  Patient (2010) Alcohol and Liver Disease, retrieved 21st September, 2010 http://www.patient.co.uk/health/Alcohol-and-Liver-Disease.htm Protzer U. & Weber O. (2008) Comparative Hepatitis: Birkhaüser advances in infectious diseasesI, np. Shetty K & Wu G. (2009) Chronic Viral Hepatitis, Clinical Gastroenterology (2nd ed), np. Sukerek, H.H. and El-Baba, M. (2010). Autoimmune Chronic Active Hepatitis: Differential Diagnosis and Work-up. Retrieved from www.emedicine.medscape.com/article/926905-diagnosis University of Texas Health Science Center (2009) Orthotopic Liver Transplant (OLT) Recipients With Hepatitis C Virus (HCV) Under Preemptive Treatment, Houston, The University of Texas Health Science Center. Wrong Diagnosis (2010) Chronic Active Hepatitis, retrieved 21st September, 2010 http://www.wrongdiagnosis.com/medical/chronic_active_hepatitis.htm Read More