You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient?
A. “Now I can never get hepatitis again.”
B. “I can safely give blood after 3 months.”
C. “I’ll never have a problem with my liver again, even if I drink alcohol.”
D. “My family knows that if I get tired and start vomiting, I may be getting sick again.”
Correct Answer: D. “My family knows that if I get tired and start vomiting, I may be getting sick again.”
Hepatitis B can recur. Patients infected with HBV could be asymptomatic initially and, depending on the particular genotype, might not be symptomatic throughout the infected state. In these particular cases, careful history taking is important to establish a diagnosis. However, when symptomatic from acute HBV infection, patients can present with serum sickness-like syndrome manifested as fever, skin rash, arthralgia, and arthritis. This syndrome usually subsides with the onset of jaundice. Patients may also have fatigue, abdominal pain, nausea, and anorexia.
Option A: Unlike hepatitis A and hepatitis E, in which there is no chronic state, HBV infection has the potential for the development of a chronic state. Chronic hepatitis B predisposes a patient to the development of portal hypertension, cirrhosis, and its complications or hepatocellular carcinoma (HCC).
Option B: Patients who have had hepatitis are permanently barred from donating blood. HBsAg is transmitted via blood contact or body secretions, and the risk of acquiring hepatitis B is considerably higher in individuals with close contact with HBsAg-positive patients.
Option C: Alcohol is metabolized by the liver and should be avoided by those who have or had hepatitis B. As such, patients with HBV infection should be monitored closely, and a referral to a specialist is highly recommended. Fulminant liver failure from HBV infection requires an emergent liver transplant evaluation at a liver transplant center.
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