Infectious mononucleosis

Disease Description (Causes and Symptoms)

Hepatitis is inflammation that occurs in liver cells. Its causes are broadly classified as viruses (A, B, C, D, E, etc.), alcohol, drugs and toxic substances, autoimmune diseases, metabolic diseases (e.g., Wilson disease), and nonalcoholic steatohepatitis. Its pathophysiology involves destruction of liver cells or persistent inflammation due to infection or toxic/immune-mediated injury, resulting in reduced liver synthesis and detoxification functions. Major symptoms range from no symptoms to fatigue and malaise, loss of appetite, nausea and vomiting, right upper abdominal discomfort, fever, joint and muscle pain, jaundice (yellowing of the skin and sclera), dark urine, itching, ascites and abdominal distension (in severe cases), changes in consciousness and confusion (hepatic encephalopathy), and signs of acute liver failure (bleeding tendency and coma). Hepatitis is classified as acute (within 6 months) or chronic (6 months or longer), and chronic hepatitis can progress over time to cirrhosis and liver cancer. Diagnosis and staging are confirmed using blood tests (liver function tests, bilirubin, INR, platelets, etc.), viral markers and viral load tests (e.g., HBV DNA and HCV RNA), autoimmune antibodies, metabolic tests (e.g., ceruloplasmin), abdominal ultrasonography and liver elastography (for assessing fibrosis), and, when necessary, liver biopsy.

Treatment Methods and Precautions

• General principles

  • The key points are treatment according to the cause (removing or treating the cause), liver protection, and prevention of complications.
  • Most cases of acute hepatitis recover with supportive care (rest, fluids, and nutrition), but signs of liver failure require immediate hospitalization, intensive care, and evaluation for liver transplantation.
  • Discontinue hepatotoxic drugs and supplements, particularly herbal medicines and folk remedies.

• Drug treatment (summary by cause)

  • HBV (chronic hepatitis B): Long-term oral antiviral drugs (main agents: tenofovir and entecavir) are the first-line choices. Antiviral treatment may be considered for severe acute cases or immunocompromised patients.
  • HCV (chronic hepatitis C): Highly effective treatment with oral direct-acting antivirals (DAAs; e.g., sofosbuvir/velpatasvir and glecaprevir/pibrentasvir) is used, and most cases can be cured. The choice of drug is determined according to the patient’s medical history and degree of liver fibrosis.
  • Autoimmune hepatitis: Corticosteroids (prednisone) ± immunosuppressants (e.g., azathioprine).
  • Wilson disease: Copper-chelating agents (penicillamine and trientine) or zinc therapy.
  • Drug- or toxin-induced hepatitis (e.g., acetaminophen overdose): Discontinue the causative drug and, if necessary, use an antidote (N-acetylcysteine in the case of acetaminophen).
  • Alcoholic hepatitis: Immediate abstinence from alcohol, nutritional and vitamin supplementation (e.g., thiamine), and consideration of steroids in severe cases.
  • Acute liver failure/end-stage liver failure: Liver transplantation may be considered.

• Lifestyle management and prevention

  • Avoid alcohol and hepatotoxic drugs and supplements; eat a balanced diet, maintain an appropriate weight (gradual weight loss is recommended in cases of obesity), and exercise regularly.
  • Vaccination against hepatitis B and hepatitis A (if susceptible); there is no vaccine for HCV → prevent infection (do not share needles, practice safe sex, etc.).
  • Patients with chronic liver disease require liver cancer surveillance (e.g., abdominal ultrasonography + AFP blood test) and regular follow-up.

• Precautions and risk of complications

  • Hepatic encephalopathy, bleeding tendency (coagulopathy), ascites and infection (peritonitis), kidney failure (hepatorenal syndrome), esophageal variceal bleeding, and liver cancer, among others.
  • Herbal medicines, folk remedies, and unnecessary medications are contraindicated because they may worsen liver damage.
  • For pregnancy and special conditions (children and immunocompromised patients), consult a specialist regarding the treatment and management plan.

Checklist Before an Outpatient Visit (Including What to Bring and Example Questions)

What to bring

• A list of all medications, nutritional supplements, and herbal medicines currently being taken (medication packets, if possible)
• Copies of previous test results (blood tests, ultrasonography, HBV/HCV tests, etc.)
• Vaccination records (especially hepatitis A and B)
• A record of the amount and duration of alcohol consumption, weight changes, and notes on when symptoms began and how they progressed
• Information about past liver disease, surgery, hemodialysis, blood transfusions, acupuncture, piercings, sexual contact, and other exposure history
• Allergies and pregnancy status (for women of childbearing age)

Self-records during medical visits (examples)

• Changes in urine and stool color (date of onset)
• The timing and severity of worsening symptoms such as jaundice, itching, abdominal distension, confusion, and drowsiness
• Recently taken medications and supplements and their start dates

General Example Questions to Ask the Doctor

• What is the cause and type of my hepatitis, and what is its current stage (acute/chronic and fibrosis stage)?
• Can it be cured with treatment? What is the goal of treatment?
• What are the recommended treatment options, the expected treatment duration, and the major side effects?
• When should treatment begin, and at what intervals will tests (monitoring) be needed during and after treatment?
• What is my risk of cirrhosis and liver cancer, and what is the Surveillance plan?
• If I am taking medications or supplements, can I continue taking them?
• If I am planning a pregnancy, how will treatment affect it? Is breastfeeding possible?
• What tests or preventive measures are needed for household members, family members, and sexual contacts?

Examples of Disease-Specific Questions

• (For chronic hepatitis B) My HBV DNA and ALT levels are at this level. When should I start an antiviral drug (e.g., tenofovir/entecavir)? How will the timing of discontinuation be determined?
• (For suspected or diagnosed chronic hepatitis C) Which DAA (direct-acting antiviral) combination and treatment duration are appropriate for my situation, and when will sustained virologic response (SVR), meaning viral cure after treatment, be confirmed?