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Hepatitis

Agatha M. Thrash, M.D.
Preventive Medicine

Fortunately, most cases of hepatitis are self-limiting and will heal with rest and supportive care. Bed rest has been considered important in the treatment of hepatitis in the past, but military studies reveal that even vigorous exercise begun after the acute phase is not harmful. Many authorities feel that the fatigue which accompanies the disease will limit the amount of exercise the patient feels up to, and instruct their patients to exercise but to avoid becoming overly tired. Prolonged bed rest itself can lead to weakness.

The patient often has a poor appetite, and sometimes even the smell of food cooking will cause him nausea. Helping these patients obtain adequate nourishment is often a challenge. Be sure the patient receives a nutritious breakfast as hepatitis patients tend to lose their appetites as the day wears on. Avoid heavy, greasy foods and alcoholic beverages. An oil-free diet is recommended.

Constipation should be guarded against as accumulations of stool in the large bowel allow the bloodstream to absorb more waste products such as ammonia, increasing the work load of the inflamed liver.

The patient should bathe frequently and be careful to wash the hands with soap and warm water after every bowel movement. It is best for the patient to have a separate toilet, but if this is not possible wash the toilet seat after use.

The patient should not prepare food for others or be in the food preparation area. He should use disposable eating utensils if possible; if not, his utensils should be washed separately from those of the rest of the family. Disposable eating utensils should be placed in plastic bags for disposal.

Linen and personal clothing should be laundered separately.

The hepatitis patient should be protected from toxic fumes such as cleaning liquids.

Drugs during hepatitis should be kept to a minimum as these substances are toxic to the liver. There are no antibiotics available to combat hepatitis. Birth control pills containing estrogens are known to raise the serum bilirubin levels and should not be taken. Corticosteroids given during the acute phase may lead to later relapse, and they provide no demonstrable benefit. Even aspirin is toxic to the liver.

Hot fomentations over the liver area for 15 minutes followed by a cold sponging, repeating the alternating hot and cold for four repetitions may be done on a daily basis. Finish the treatment with a shower or sponge bath.

A hot half bath may be given to raise the body temperature and assist the body in fighting the virus. The patient sits in a tub of water as hot as can be tolerated until the body temperature reaches 102 to 104° F. The water temperature may then be cooled to maintain this temperature for approximately 20 minutes. Apply washcloths wrung from ice water to the face and head to keep the head cool. Give the patient plenty of water to drink as he will lose fluids through perspiration. After 20 minutes, give a cool shower, dress the patient warmly and give him rest in bed until the sweating stops. The treatment may be given for 10 to 15 days but some patients may not be able to tolerate the physical taxation of daily treatments.

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