Hepatitis
Hepatitis A, B, and C share the same organ but differ in transmission, chronicity, and vaccine availability — confusing them costs NCLEX points and puts patients at risk.
Core Concept
Hepatitis is liver inflammation most commonly caused by viral infection. The NCLEX focuses on types A, B, and C. Hepatitis A (HAV) spreads fecal-oral, is always acute, never becomes chronic, and is preventable with a vaccine. Hepatitis B (HBV) spreads through blood and body fluids (percutaneous, sexual, perinatal), can become chronic in about 5% of immunocompetent adults (~90% in perinatally infected infants), and is preventable with a vaccine — the only hepatitis with both a vaccine and risk for chronicity. Neonates born to HBsAg-positive mothers require HBIG plus HBV vaccine within 12 hours of birth. Hepatitis C (HCV) spreads primarily through blood (IV drug use, needlesticks), has no vaccine, and becomes chronic in approximately 75-85% of those infected, making it the leading cause of liver transplant in the U.S. HCV is now curable with direct-acting antivirals (DAAs) achieving >95% sustained virologic response, making early screening and referral a nursing priority. Key lab markers: elevated ALT and AST indicate hepatocyte damage; rising bilirubin causes jaundice. Serologic markers differentiate types — anti-HAV IgM confirms acute A; HBsAg confirms active B infection; anti-HBc IgM indicates acute HBV or window period; anti-HCV confirms C exposure. Nursing priorities include standard and transmission-based precautions (contact for diapered or incontinent HAV patients; standard precautions for continent adults with HAV and for all HBV/HCV patients), monitoring for progression to fulminant liver failure, and patient education on preventing transmission.
Watch Out For
Don't confuse HBsAg (surface antigen = active infection/carrier) with anti-HBs (surface antibody = immunity from vaccine or resolved infection) — one means infectious, the other means protected. Anti-HBc IgM indicates acute HBV or the window period (HBsAg cleared, anti-HBs not yet present); anti-HBc IgG indicates past or chronic infection. Students often think hepatitis C has a vaccine because B does — it does not. HAV requires contact precautions for diapered or incontinent patients (fecal-oral route); continent adults need standard precautions only. HBV and HCV are bloodborne and require standard precautions.
Clinical Pearl
A is Acute only and has A vAccine. B is in Blood/Body fluids and has Both a vaccine and chronicity risk. C is Chronic most often and has no vaCCine (but is curable with DAAs).
Test Your Knowledge
3 quick questions — see how well you understood Hepatitis