HEPATITIS D

Hepatitis D, also referred to as hepatitis D virus (HDV) and classified as Hepatitis delta virus, is a disease caused by a small circular enveloped RNA virus. It is one of five known hepatitis viruses: A, B, C, D, and E. HDV is considered to be a subviral satellite because it can propagate only in the presence of the hepatitis B virus (HBV). Transmission of HDV can occur either via simultaneous infection with HBV (coinfection) or via infection of an individual previously infected with HBV (superinfection).

Both superinfection and coinfection with HDV results in more severe complications compared to infection with HBV alone. These complications include a greater likelihood of experiencing liver failure in acute infections and a rapid progression to liver cirrhosis, with an increased chance of developing liver cancer in chronic infections.[2] In combination with hepatitis B virus, hepatitis D has the highest mortality rate of all the hepatitis infections of 20%.

Pathophysiology

The etiologic agent, mode of transmission, and clinical course vary according to the hepatitis type. However, the pathophysiology is the same. The causative agent invades the mononuclear cells in the liver, replicates, and sets up an inflammatory process in the parenchyma and portal ducts, causing hepatic cell necrosis, cellular collapse, and accumulation of necrotic tissue in the lobules and portal ducts. This results in interference with bilirubin excretion. Cellular regeneration and mitosis occur simultaneously with cellular necrosis, and the liver regenerates within 2 to 3 months. Continuation of the inflammatory response sets up a chronic disease process.

Causative Agent

Targeting the causative agent of Hepatitis B may also kill the causative agent of Hepatitis D.

Incubation Period

HAV: 15 to 50 days; HBV: 45 to 180 days; HCV: 14 to 182 days; HDV: 14 to 70 days; HEV: 15 to 64 daysCommunicabilityHAV: last half of incubation until 1 week after onset of jaundice; HBV: during incubation and entire clinical course (carrier state may persist for years); HCV: 1 week before clinical onset to indefinite period of time as carrier; HDV: throughout clinical disease; HEV: unknown

Medical Management

1. Targeting the causative agent of Hepatitis B may also kill the causative agent of Hepatitis D.

2. Interferon is under investigation as a specific treatment for Hepatitis D.3. Acyclovir, ribavirin, lamivudine and synthetic analogues of thymosin have proved

ineffective.

Nursing Management

1. Inform the patient and family members about the nature of the disease if the patient is taken care at home.

2. Assist is paracentesis if indicated.3. Patients with cirrhosis could be in deep pain and discomfort, use of analgesics should

be administered with great caution since it can worsen the liver damage.4. Diversionary therapy and non-pharmacological approach should be applied in

managing pain.5. Ongoing monitoring of vital signs, abdominal girth and reminding for the routine

check-up must be emphasized for effective management.Photo credits: www.google.com.ph