Master Hepatitis B (HBV) Assessment with Picmonic for Physician Assistant

Close contact with infected individuals and their bodily fluids can lead to contraction of the HBV. This includes sexual contact with an infected partner in which exposure to saliva, blood, semen, or vaginal secretions enter the body. Additionally, casual contact in the form of open sores or cuts can lead to infection. Higher vaccination rates have led to decreased cases, but some patients are still unvaccinated. HBV is still spread via men having sex with men and IV drug use. However, the greatest cases result from heterosexual transmission. Of all those treated with acute Hep B in the US, half have either been incarcerated or treated for a STD previously.

Hepatitis B virus can be spread by exposure to infectious blood. This includes perinatal transmission, which means a mother can pass the virus to the fetus during childbirth. Additionally, accidental needle sticks contaminated with infected blood are another source of transmission. Laboratories, clinics and blood banks still remain a high risk of transmission for both patients and staff.

People who use IV drugs are at an increased risk of contracting hepatitis B, as the virus is easily transmitted through needles and syringes contaminated with infected blood. Encourage patients to seek out safe supplies wherever they are distributed or offer them to clients if on hand. It is possible to inject drugs safely and maintain healthy sexual practices if access to harm reduction supplies such as clean needles, syringes and condoms are offered freely without judgement and stigma.

The incubation period for hepatitis B is quite variable with a range of 1 to 6 months. (average 12 to 14 weeks). Patients are infectious for 4-6 months and carriers continue to be infectious for life.

Manifestations of hepatitis B often resemble flu-like symptoms and often don’t appear until the individual has had the virus for a couple weeks. A low-grade fever may be present.

The individual may experience nausea and vomiting, as well as generalized weakness and fatigue, and loss of appetite. An aversion to smoking might be noted in some individuals.

Symptoms of hepatitis B are rarely severe unless there is underlying liver failure. Some patients may experience hepatomegaly, or swelling of the liver beyond normal. Assess for enlarged and tender liver, and jaundice.

Approximately 10 percent of individuals infected with the HBV, usually immunosuppressed individuals, can develop chronic hepatitis B. Chronic hepatitis B may eventually cause cirrhosis (scarring of the liver).

Chronic hepatitis B affects over 200 million worldwide and may also lead to hepatocellular carcinoma or liver cancer. Screen patients with HIV and chronic hepatitis B infection for hepatocellular carcinoma.

Hepatitis B is preventable by vaccination. The incidence of HBV infection has decreased significantly due to the widespread use of the HBV vaccine.