COURSE AND PROGNOSIS
About 85 percent of the patients suffering from infectious hepatitis recover
without complications in about 6 to 8 weeks. The fatality rate is 0 to 1 percent. If a
complication does appear, it will be one of the following.
a. Relapse. About 2 to 18 percent with this disease experience a form of
relapse. Sometimes, this is a milder form of the original attack. More than 1 relapse
may occur, but recovery is almost always complete.
b. Prolonged Viral Hepatitis. In about 5 percent of the cases, the course of the
disease can last up to a year. Usually there is complete recovery.
c. Cholestatis Hepatitis. The jaundice in this variation can last up to 30 weeks.
This is also followed by complete recovery.
d. Submassive Necrosis. Extensive necrosis develops early in the course of
the disease. About 1/3 of the patients die in a few months. About 1 1/2 continue over a
6-month period and develop cirrhosis. This form is often seen in women over 35 years
e. Fulminant Hepatitis. This is usually a fatal complication. The patient shows
a rapid and steady deterioration and develops a hepatic coma and deep jaundice. The
liver shows massive necrosis and shrinks in size. It is usually fatal within 10 days. This
complication has also been known as "acute yellow atrophy."
TREATMENT AND NURSING CARE
Diet and activity should be adjusted to the clinical condition of the patient. The
extremely ill patient will not want ambulation and may have nausea and vomiting so
severe as to require supplements with 10 percent glucose solution. After gradually
increasing ambulation, the patient may return to normal activity when he is
asymptomatic and the liver tenderness has subsided. There is no specific medical
treatment for viral hepatitis. Good general care is required. Pay attention to good oral
hygiene, skin care, and elimination. Encourage fluids by mouth if nausea is not a
problem. It may be necessary to entice the patient to eat. He may resist eating at first
but eventually he will recover his appetite. When the appetite has returned to normal, a
diet high in calories, proteins, and moderate carbohydrates is usually ordered. Fats
may or may not be limited and vitamins may be given. For the patient with fulminant
hepatitis, the common complications are hepatic coma, renal failure, and there is a
severe bleeding tendency. Specific therapy should be directed to these complications
as they arise. Prednisone has been used to promote regeneration but the therapeutic
value of these agents is not certain. Exchange transfusion has apparently enabled
some patients to recover. This treatment is reserved for the seriously ill patient with
hepatic coma and fulminant hepatitis. It may be necessary to repeat the exchange
transfusion on successive days before a response is obtained.