Medical Surgical Nursing

Clinical Manifestations

 Clinically, the disease closely resembles hepatitis A, but the incubation period is

much longer (1 to 6 months). Signs and symptoms of hepatitis B may be

insidious and variable. Fever and respiratory symptoms are rare; some patients

have arthralgias and rashes.

 The patient may have loss of appetite, dyspepsia, abdominal pain, generalized

aching, malaise, and weakness. Jaundice may or may not be evident. light-

colored stools and dark urine.

 The liver may be tender and enlarged. The spleen is enlarged and palpable in a

few patients; the posterior cervical lymph nodes may also be enlarged.

 Assessment and Diagnostic Findings

 HBV is a DNA virus composed of the following antigenic particles :

 HBcAg—hepatitis B core antigen (antigenic material in an inner core

 HBsAg—hepatitis B surface antigen (antigenic material on surface of HBV

 HBeAg—an independent protein circulating in the blood

 HBxAg—gene product of X gene of HBV/DNA

 Each antigen elicits its specific antibody and is a marker for different stages of

the disease process :

 Anti-HBc—antibody to core antigen or HBV; persists during the acute phase of

illness; may indicate continuing HB in the liver

 Anti-HBs—antibody to surface determinants on HBV; detected during late

convalescence; usually indicates recovery and development of immunity. It

appears in the circulation in 80% to 90% of infected patients 1 to 10 weeks after

exposure, if continues for > 6 months, pt is considered a HBsAg carrier

 Anti-HBe—antibody to hepatitis B e-antigen; usually signifies reduced

infectivity

 • anti-HBxAg—antibody to the hepatitis B x-antigen; may indicate ongoing

replication of HBV

Prevention

 The goals of prevention are to interrupt the chain of transmission, to protect

people at high risk with active immunization through the use of hepatitis B

vaccine, and to use passive immunization for unprotected people exposed to

HBV.