Disease Description (Causes and Symptoms)
Acute viral hepatitis is an acute inflammatory disease caused by infection of the liver with various viruses (hepatitis A, B, C, D, E, and G viruses, as well as Epstein–Barr virus, cytomegalovirus, and others).
- Pathophysiology: Viruses infiltrate hepatocytes and cause direct damage, or hepatocyte damage occurs through the host immune response (such as cell-mediated immunity). Symptoms vary depending on the type of virus and the patient's immune status.
- Main symptoms: Fatigue, malaise, fever or cold-like symptoms, loss of appetite, nausea and vomiting, muscle aches and joint pain, abdominal discomfort, jaundice (yellowing of the whites of the eyes and skin), itching, and others. Most people recover within 6 months with supportive treatment. Some (approximately 1%) may progress to acute liver failure (including altered mental status and coagulation abnormalities).
Treatment Methods
- General principles
- Most cases of acute viral hepatitis recover with supportive treatment (rest, hydration and nutritional support, and avoidance of medications that place a burden on the liver) without specific antiviral drugs.
- If signs of liver failure are present (coma, elevated INR, rapidly rising bilirubin, etc.), hospitalization, intensive care, and consideration of liver transplantation are required.
- Main treatment/management by virus
- Hepatitis A and E: Generally supportive treatment. Patients with severe disease (liver failure) require hospitalization. Prevention includes hepatitis A vaccination (recommended) and proper hygiene.
- Hepatitis B: Most cases are managed conservatively during the acute phase. However, antiviral treatment (e.g., tenofovir-class drugs or entecavir) may be considered in cases of severe hepatitis (very high ALT, elevated INR, or progressive jaundice) or in progressive/severe patients. Follow-up is needed in acute hepatitis B to determine whether it becomes chronic (regular HBsAg/ALT testing).
- Hepatitis C: Spontaneous remission is possible in many cases, but some become chronic. When persistent virus detection during the acute phase and the risk of chronic infection are assessed, early treatment with direct-acting antivirals (DAAs; e.g., glecaprevir/pibrentasvir) may be considered (depending on management recommendations and the patient's condition).
- Hepatitis D: Because it occurs as a coinfection or superinfection with hepatitis B, the principles of HBV treatment are followed. Specialist judgment is required in severe cases.
- Other viruses (EBV, CMV): Supportive treatment according to symptoms; antiviral drugs may be considered in immunocompromised patients.
- Lifestyle management and precautions
- Complete abstinence from alcohol (including before and after recovery). Hepatotoxic medications (including some antibiotics and painkillers), herbal medicines, and folk remedies are prohibited or should be discussed with a doctor.
- Get adequate rest, eat a balanced diet (maintaining adequate protein intake), and avoid excessive physical activity.
- Prevent transmission through food hygiene and handwashing, protection during sexual contact, and prevention of blood exposure during invasive procedures.
- Severe disease criteria (consider immediate referral/hospitalization)
- Altered mental status (hepatic encephalopathy), INR ≥ 1.5 or a rising trend, rapidly increasing bilirubin, bleeding tendency, or signs of liver failure.
Checklist Before an Outpatient Visit (Including Example Questions)
Items to prepare and check
- A list of all medications currently being taken (including prescription drugs, OTC medications, herbal medicines, and dietary supplements)
- History of previous liver disease, vaccination history (hepatitis A and B), and blood test results (if possible, recent liver function tests, HBsAg, anti-HCV, etc.)
- When symptoms began (the start date of jaundice, fever, and nausea), and a record of symptom changes (fever pattern, changes in urine and stool, etc.)
- Amount of alcohol consumption and recent exposure history (blood transfusion, injections or invasive procedures, sexual contact, overseas travel, consumption of contaminated food or water, etc.)
- Whether pregnant (women) — the risk of severe disease from HEV is higher in pregnant women
- Whether immunocompromised (e.g., chemotherapy or steroids) Example questions (to check when coming to the hospital)
- On what date did the symptoms begin?
- Has anyone else recently (family members or coworkers) had similar symptoms? Have you traveled overseas or eaten contaminated food?
- Are you currently taking any medications or herbal medicines? How often do you drink alcohol?
- Have there been any changes in the color of your urine or stool (such as dark urine or pale stool)?
Examples of General Questions to Ask the Doctor
- What do the results of these tests (liver enzymes and viral tests) mean? How serious is the condition of my liver?
- What treatment is needed, and what are the effects and side effects of the medication?
- How likely is it that hospitalization or a liver transplant will be needed?
- How high is the risk of recurrence or chronic infection? How should follow-up testing be conducted?
- When can I return to normal daily activities (exercise, returning to work, diet, alcohol consumption, etc.)?
Examples of Disease-Specific Questions
- (Regarding HBV) Based on my HBsAg/anti-HBc results, what is my risk of developing chronic infection, and what is the follow-up plan? Is this a situation in which antiviral treatment is needed?
- (Regarding HCV) When is it appropriate to start a DAA (direct-acting antiviral) for acute hepatitis C? Should treatment begin immediately, or should the decision be made after observing the course of the disease?
Additional Information (Prevention and Complications)
- Prevention: Hepatitis A and B vaccination is recommended, along with safe blood management, safe needle use, sexual protection, and hand hygiene.
- Complications: Acute liver failure, chronic infection (mainly hepatitis B/C), cirrhosis and liver cancer (long-term risks after chronic infection), cholestatic symptoms, and others.
(The information above is general medical information. Please consult your doctor regarding individual diagnosis and treatment.)