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Treatments for Hepatitis A
Treatment list for Hepatitis A:
The list of treatments mentioned in various sources for Hepatitis A includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
Treatments of Hepatitis A: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Hepatitis A.
Hepatomegaly:
Treatment
(In a Page: Signs and Symptoms)
- Heart failure: Diuretics, inotropes, and afterload reduction
- Viral hepatitis: Supportive care and antivirals in some chronic cases
- Alcoholic liver disease: Abstinence from alcohol, steroids in severe cases, and possible transplant
- Fatty liver: Treat underlying obesity, diabetes, hyperlipidemia
- Sarcoidosis: Steroids
- Hemochromatosis: Iron removal by weekly phlebotomy for 2–3 years and/or deferoxamine chelation
- Wilson's disease: Copper chelation with D-penicillamine or trientine; may require liver transplantation
- Neoplasms: Resection and chemotherapy
- Abscess or cyst: Antimicrobials, percutaneous drainage, and/or surgical resection
- Amyloidosis: Prednisone and alkylating agents
Jaundice:
Treatment
(In a Page: Signs and Symptoms)
- Discontinue and avoid potentially hepatotoxic medications
- Supportive care for viral hepatitis
- Rehydrate/refeed for Gilbert's syndrome
- Consider steroids in fulminant alcoholic hepatitis
- Cholecystectomy or ERCP with stone removal for obstructing gallstones
- Treat underlying causes of hemolysis or other disorders
- Antibiotics for cholangitis, sepsis
- Hydroxyurea and folate for sickle cell disease, prevent crises by adequate hydration, vaccinating against diseases, and try to prevent other infections
Hepatomegaly:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Geared towards specific disease
-
Cholestasis
–Ursodeoxycholic acid
–Supplemental fat soluble vitamins A, D, E, K -
Infections
–Consider interferon for hepatitis B
–Consider interferon and ribaviron for hepatitis C -
Toxins
–Use of NTBC for tyrosinemia -
Metabolic disease
–Metabolism consultation
–Often requires specific restricted formulas -
Surgical repair for biliary atresia
–Kasai portoenterostomy has better outcome if done before 60 days of age - Mucomyst for acute acetaminophen toxicity
- Immune suppression for autoimmune hepatitis
Jaundice in Infants – Direct:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Varies by specific disorder
-
General medication principles of cholestasis include
–Promoting bile flow with ursodeoxycholic acid
–Consider phenobarbital (increases bile excretion)
–Fat-soluble vitamins including K, D, E
–Vitamin A is a relative contraindication given hepatotoxicity at high levels
–Kasai portoenterostomy for biliary atresia
–Surgical repair of choledochal cyst
–Special formulas for tyrosinemia
–Lactose free formula for galactosemia (e.g., soy based)
–Remove toxic exposures
–Treat infections
–Treat hypothyroidism
Jaundice in Infants – Indirect:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treatment options vary based on level of bilirubin, age of presentation, and cause
–Goal is prevent levels high enough to cause kernicterus -
Phototherapy involves the use of photon energy to change the structure of bilirubin and permit excretion without glucuronidation
–Decisions for use are age-based
–Considered when serum level above 14 mg/dL - Exchange transfusion should be considered with serum levels above 25 mg/dL
-
IVF or breast-feed more frequently to increase volume
- Correct endocrine abnormality
- Improve perfusion if cardiac problem
- Correct anatomic abnormality
-
Consider enteral binding agents
–Cholestyramine, charcoal, calcium phosphate - Crigler-Najjar: Phenobarbital, may need liver transplantation
Viral hepatitis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
No specific drug therapy has been developed for hepatitis, with the exception of hepatitis C, which has been treated somewhat successfully with interferon alpha. Instead, patients are advised to rest in the early stages of the illness and to combat anorexia by eating small, high-calorie, high-protein meals. (Protein intake should be reduced if signs or symptoms of pre-coma — lethargy, confusion, and mental changes — develop.) Large meals are usually better tolerated in the morning because many patients experience nausea late in the day.
In acute viral hepatitis, hospitalization usually is required only for the patient with severe symptoms or complications. Parenteral nutrition may be required if the patient experiences persistent vomiting and is unable to maintain oral intake.
Antiemetics may be given 30 minutes before meals to relieve nausea and prevent vomiting; phenothiazines have a cholestatic effect and should be avoided. For severe pruritus, the resin cholestyramine may be given.
Nonviral hepatitis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment must remove the causative agent by lavage, catharsis, or hyperventilation, depending on the route of exposure. Acetylcysteine may serve as an antidote for toxic hepatitis caused by acetaminophen poisoning but doesn’t prevent drug-induced hepatitis caused by other substances. Corticosteroids may be ordered for patients with the drug-induced type.
Hepatic encephalopathy:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment stops progression of encephalopathy by reducing blood ammonia levels. Treatment includes eliminating ammonia-producing substances from the GI tract by administering neomycin to suppress bacterial flora (preventing them from converting amino acids into ammonia), performing sorbitol-induced catharsis to produce osmotic diarrhea and continuous aspiration of blood from the stomach, and reducing dietary protein intake.
Lactulose, which traps ammonia in the bowel and promotes its excretion, is administered to reduce blood ammonia levels. Bacterial enzymes change lactulose to lactic acid, thereby rendering the colon too acidic for bacterial growth. At the same time, the resulting increase in free hydrogen ions prevents diffusion of ammonia through the mucosa; lactulose promotes conversion of systemically absorbable ammonia to ammonium, which is poorly absorbed and can be excreted. It’s usually given orally. However, if the patient is in a coma, it may be administered by retention enema.
Treatment may also include potassium supplements to correct alkalosis due to increased ammonia levels, especially if the patient is taking diuretics. Hemodialysis may sometimes be used to clear toxic blood temporarily. Salt-poor albumin may be used to maintain fluid and electrolyte balance, replace depleted albumin levels, and restore plasma. Sedatives, tranquilizers, and other medications metabolized or excreted by the liver should be avoided if possible. Medications containing ammonium (including certain antacids) should also be avoided.
Jaundice [Icterus]:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals.
Hepatitis, viral:
Treatment
(Handbook of Diseases)
No specific drug therapy has been developed for hepatitis, with the exception of hepatitis C, which has been treated somewhat successfully with interferon alfa-2b and the more recently FDA-approved peginterferon alfa-2a. Instead, the patient is advised to rest in the early stages of the illness and to combat anorexia by eating small, high-protein meals.
Clinical tip The largest meal should be eaten in the morning because nausea tends to intensify as the day progresses.
Protein intake should be reduced if signs of precoma — lethargy, confusion, and mental changes — develop.
In acute viral hepatitis, hospitalization is usually required only for patients with severe symptoms (severe nausea, vomiting, change in mental status, and PT greater than 3 seconds above normal) or complications. Parenteral nutrition may be required if the patient experiences persistent vomiting and can’t maintain oral intake.
Antiemetics (diphenhydramine or prochlorperazine) may be given 30 minutes before meals to relieve nausea and prevent vomiting; phenothiazines have a cholestatic effect and should be avoided. For severe pruritus, the resin cholestyramine may be given.
Hepatitis, nonviral:
Treatment
(Handbook of Diseases)
Effective treatment must remove the causative agent by lavage, catharsis, or hyperventilation, depending on the route of exposure. Acetylcysteine may serve as an antidote for toxic hepatitis caused by acetaminophen poisoning but doesn’t prevent drug-induced hep-atitis caused by other substances.
Corticosteroids may be prescribed for patients with drug-induced hepatitis.
Hepatic encephalopathy:
Treatment
(Handbook of Diseases)
Effective treatment stops the progression of encephalopathy by reducing blood ammonia levels. Such treatment eliminates ammonia-producing substances from the GI tract by:
❑ administration of lactulose to reduce the blood ammonia levels and use of sorbitol-induced catharsis to produce osmotic diarrhea; neomycin therapy may be added if lactulose alone doesn’t reduce ammonia levels
❑ reduction of dietary protein intake
❑ continuous aspiration of blood from the stomach.
Lactulose
Lactulose traps ammonia in the bowel and promotes its excretion. It’s effective because bacterial enzymes change lactulose to lactic acid, thereby rendering the colon too acidic for bacterial growth. At the same time, the resulting increase in free hydrogen ions prevents diffusion of ammonia through the mucosa; lactulose promotes conversion of systemically absorbable ammonia to ammonium, which is poorly absorbed and can be excreted.
The usual dosage of lactulose syrup is 30 to 45 ml by mouth (P.O.) three or four times daily. For acute hepatic coma, 300 ml of lactulose syrup diluted with 700 ml of water may be administered by retention enema. Lactulose therapy requires careful monitoring of fluid and electrolyte balance.
Neomycin
Neomycin is usually given in a dose of 3 to 4 g daily P.O. or by retention enema. Although neomycin is nonabsorbable at the recommended dosage, an amount that exceeds 4 g daily may produce irreversible hearing loss and nephrotoxicity after prolonged use.
Other treatments
Treatment may also include potassium supplements to correct alkalosis (from increased ammonia levels), especially if the patient is taking diuretics.
Hepatomegaly:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to avoid alcohol. Explain the importance of following the treatment plan to correct or control the underlying disorder as needed. Tell the patient to avoid exposure to people with infections and to maintain good personal hygiene. Explain the importance of pacing activities and having frequent rest periods.
Jaundice:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals. Teach the patient ways to reduce pruritus.
Hepatomegaly:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for liver enzyme, alkaline phosphatase, bilirubin, albumin, and globulin studies to evaluate liver function and for X-rays, a liver scan, celiac arteriography, a computed tomography scan, and ultrasonography to confirm hepatomegaly.
▪ Provide bed rest, relief from stress, and adequate nutrition to help protect liver cells from further damage and to allow the liver to regenerate functioning cells.
▪ Monitor and restrict dietary protein as needed.
▪ Give hepatotoxic drugs or drugs metabolized by the liver in very small doses, if at all.
Patient teaching
▪ Explain the underlying disorder and its treatments.
▪ Stress the importance of avoiding alcohol and people with infections.
▪ Discuss the importance of pacing activities and rest periods.
Jaundice [Icterus]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To decrease pruritus, frequently bathe the patient; apply an antipruritic lotion, such as calamine; and administer diphenhydramine or hydroxyzine.
▪ Prepare the patient for diagnostic tests to evaluate biliary and hepatic function, including laboratory studies (such as urine and fecal urobilinogen, serum bilirubin, liver enzyme, and cholesterol levels; prothrombin time; and a complete blood count), computed tomography, ultrasonography, cholangiography, liver biopsy, and exploratory laparotomy.
Patient teaching
▪ Teach the patient appropriate dietary changes.
▪ Discuss ways to reduce pruritis.
▪ Review with the patient prescribed medications and their possible adverse effects.
Discussion of treatments for Hepatitis A:
Viral Hepatitis A to E and Beyond: NIDDK (Excerpt)
Hepatitis A usually resolves on its own over several weeks. (Source: excerpt from Viral Hepatitis A to E and Beyond: NIDDK)
Vaccinations for Hepatitis A & B: NIDDK (Excerpt)
Immune globulin is more than 85 percent effective in preventing hepatitis A virus infection when given within 2 weeks of exposure to the hepatitis A virus. The dose is 0.02 mL/kg injected into the gluteal muscle in adults or the anterolateral thigh muscle in children under 2 years. Concurrent hepatitis A vaccination may also be appropriate in people 2 years and older. (Source: excerpt from Vaccinations for Hepatitis A & B: NIDDK)
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