b. Symptoms and Pathology. The symptoms resemble those of serum
hepatitis but are frequently less severe. There is generally no jaundice, but the liver is
large and tender. In most patients, the onset is insidious. The disease waxes and
wanes over many months or years. If arthritis appears as a symptom, the disease is
called "lupoid hepatitis." There is probably a chronic carrier state. Incubation appears
to be about 2 months.
c. Course and Prognosis. The Non-A/Non-B type hepatitis may clear by itself
after a few months or years. After several years, it may progress to cirrhosis.
d. Treatment and Nursing Care. Prednisone orally has been used when
symptoms warranted therapy. Gamma globulin significantly reduces incidence of this
type of hepatitis and reduces the incidence of chronic active liver disease.
e. Prophylaxis. Care must be taken to reject blood donors who have had
serum hepatitis and to transfuse a patient only when this is justified. When it is
available, hepatitis B vaccine should be administered. The directions for use and
disposal of transfusion equipment are the same for all forms of hepatitis.
4-17. TOXIC HEPATITIS
Toxic hepatitis is hepatitis caused by the direct action of poison on the liver cells.
These chemicals may be taken into the system by inhalation, ingestion, skin absorption,
or injection. The chemicals can cause liver poisoning, a hepatitis-like reaction, an
allergic reaction that inhibits the flow of bile (hypersensitivity cholestasis) or bile flow
inhibited by steroids (steroid cholestasis).
a. Causes. A direct toxic effect may be caused by carbon tetrachloride,
insecticides, industrial solvents, various metallic compounds (i.e., arsenic, gold,
mercury, iron), and hydrazine drugs such as isoniazid and halothane anesthetics. The
latter two may produce a condition indistinguishable from that of acute viral hepatitis.
b. Effects. These poisons may produce any or all of these effects: nausea,
vomiting, jaundice, stupor, or coma.
c. Treatment. The primary treatment is to remove the patient from further
exposure to the offending substance, if it is known. Further treatment varies with the
causative agent. General treatment is bed rest and supportive care.
d. Prognosis. The extent of damage is related to the dose of the substance.
Some patients recover with little residual hepatic damage and some have severe