Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Hepatitis B

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In one line

·Hepatitis B is a virus that attacks liver cells and spreads through blood, sex, or from mother to baby during birth.

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Normal physiology

·Your liver is a dark-red, football-sized organ tucked under your right ribs. It is made of millions of tiny cells called hepatocytes, and these cells do three big jobs every minute of every day: they filter toxins out of your blood (like ammonia from digesting protein), they make proteins that stop bleeding (clotting factors), and they store sugar (glycogen) to fuel your body between meals. Hepatocytes are tough — if some die, the liver can grow new ones to replace them, as long as the damage is not constant.

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What goes wrong

·Hepatitis B virus (HBV) sneaks into a hepatocyte, takes over the cell's machinery, and forces it to make millions of new virus copies. Your immune system's T-cells (the soldiers that hunt infected cells) see the virus flag on the hepatocyte surface and kill the infected cell to stop the virus from spreading. In most adults, T-cells clear every infected cell within three to six months and the liver heals completely. But in some people — especially babies and young children whose immune systems are still learning, and some adults with weaker immune defenses — the T-cells cannot finish the job, so the virus hides in hepatocytes for years. That low-level infection keeps triggering inflammation, and chronic inflammation slowly turns liver tissue into stiff scar tissue (fibrosis). Once enough scar builds up, you have cirrhosis, and a cirrhotic liver cannot do its three main jobs anymore. Worse, hepatocytes that keep dividing under constant viral attack and inflammation pile up DNA mistakes, and some of those mistakes turn into hepatocellular carcinoma (liver cancer).

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Hallmark signs

·No symptoms at all (most common in chronic infection)
·Fatigue and feeling worn out
·Loss of appetite and nausea
·Yellow skin and eyes (jaundice)
·Dark urine that looks like tea or cola
·Pale or clay-colored stools
·Pain or fullness in the upper right belly
·Joint pain and muscle aches

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Red flags · escalate now

·Yellow skin or eyes (jaundice) — means the liver is struggling to clean the blood
·Confusion, extreme sleepiness, or changes in personality — toxins may be building up in the brain
·Easy bruising, bleeding gums, or vomiting blood — the liver isn't making clotting proteins, so bleeding won't stop
·Swollen belly with fluid (ascites) or swollen legs — the liver isn't making enough albumin to hold fluid in the blood vessels
·Severe fatigue with yellowing of the skin and eyes (jaundice) in someone who was recently exposed to the virus — may be acute hepatitis B, which can turn severe quickly

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Workup

·HBsAg (Hepatitis B surface antigen)
·Anti-HBc IgM (antibody to Hepatitis B core antigen, IgM type)
·HBeAg (Hepatitis B e antigen) and HBV DNA level (viral load)
·ALT (alanine aminotransferase) and AST (aspartate aminotransferase)
·INR (international normalized ratio) or PT (prothrombin time)
·Liver elastography (FibroScan) or liver biopsy
·AFP (alpha-fetoprotein) and abdominal ultrasound every 6 months in chronic Hepatitis B with cirrhosis or high-risk groups

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Treatment

·Supportive care in acute Hepatitis B: IV fluids for dehydration, rest, nutrition, and close monitoring of mental status, INR, and bilirubin
·Antiviral therapy with entecavir or tenofovir (TDF or TAF) for chronic Hepatitis B when HBV DNA is above 2,000 IU/mL, ALT is elevated, and there is evidence of fibrosis or cirrhosis
·HBIG (Hepatitis B immune globulin) plus the Hepatitis B vaccine series given to newborns of HBsAg-positive mothers within 12 hours of birth
·Tenofovir (TDF or TAF) started in the third trimester (around 28 to 32 weeks) for pregnant women with HBV DNA above 200,000 IU/mL
·Hepatocellular carcinoma screening with abdominal ultrasound (and sometimes AFP) every 6 months in patients with cirrhosis or chronic Hepatitis B in high-risk groups (Asian men over 40, Asian women over 50, Africans over 20, anyone with a family history of liver cancer)
·Hepatitis B vaccination for all close contacts, household members, sexual partners, and healthcare workers exposed to the patient

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NCLEX trap

·Hepatitis B is caused by a virus, not bacteria. Antibiotics do not kill viruses. For chronic Hepatitis B with high viral load and liver damage, you give antiviral drugs (tenofovir or entecavir). For acute Hepatitis B, you give supportive care (fluids, rest, symptom relief) and monitor closely. Always test for the virus first—do not guess based on symptoms alone.
·Hepatitis B can show up quietly—sometimes the only signs are yellowing of the skin and eyes (jaundice) (yellow skin and eyes) and feeling exhausted. Many people with Hepatitis B never run a fever. Do not wait for textbook symptoms. Test anyone with yellowing of the skin and eyes for Hepatitis B.
·Only treat chronic Hepatitis B if the HBV DNA (virus count) is high AND the ALT (liver enzyme showing damage) is elevated AND there is evidence of liver scarring or inflammation on imaging or biopsy. People who carry the virus quietly with low viral load and normal liver tests may only need regular monitoring. Treat the damage, not just the presence of the virus.
·Chronic Hepatitis B needs long-term suppression to keep the virus quiet. Stopping antivirals allows the virus to wake back up and damage the liver all over again. Keep the patient on tenofovir or entecavir indefinitely unless there is a specific safe stopping rule (like HBsAg loss with anti-HBs antibody).
·Newborns of mothers who are HBsAg-positive (carrying Hepatitis B) need BOTH hepatitis B immunoglobulin (HBIG) within 12 hours of birth AND the full vaccine series starting at birth. HBIG gives immediate borrowed antibodies to fight the virus right away; the vaccine teaches the baby's own immune system to make antibodies over time. Both together prevent the baby from catching Hepatitis B from the mother.
·During the window period (the first few weeks after infection, before the body makes antibodies), the HBsAg may be negative even though the virus is actively replicating. If you suspect Hepatitis B based on symptoms or exposure, repeat the test in 1–2 weeks or order HBV DNA directly to catch the virus early. Do not miss early Hepatitis B because of one negative test.

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