Hepatitis

Disease Description (Causes and Symptoms)

• Definition summary: Hepatitis is a general term for a condition in which inflammation develops in liver cell tissue. It is classified as acute (≤6 months) or chronic (>6 months).
• Main causes: Viral infections (mainly types A, B, C, D, and E), drugs and toxins (e.g., acetaminophen overdose, some herbal medicines and supplements), excessive alcohol consumption, autoimmune diseases, metabolic diseases (e.g., Wilson disease), and others.
• Pathophysiology summary: Depending on the cause, direct liver cell injury or immune-mediated destruction of liver cells occurs, resulting in reduced liver function (detoxification, synthesis, bile production, etc.). Recurrent or persistent inflammation may progress to fibrosis and cirrhosis.
• Main symptoms: Fatigue, weakness, loss of appetite, nausea and vomiting, discomfort in the right upper abdomen, fever, muscle and joint pain, jaundice (yellowing of the whites of the eyes and skin), dark urine, pale stools, and itchy skin. In severe cases, ascites, hepatic encephalopathy, and symptoms of liver failure (bleeding tendency and decreased consciousness) may occur.

Treatment Methods and Precautions

• General principles: Treatment of the cause (specific treatment) + supportive care (rest, fluid and nutritional supplementation, and avoidance of hepatotoxic substances).
• Viral hepatitis
  • Hepatitis A and E: Usually resolve spontaneously → supportive care. Hospitalization if severe.
  • Hepatitis B
    • Most acute cases receive conservative treatment. Antiviral treatment may be considered in acute liver failure or high-risk groups (e.g., people receiving immunosuppressive therapy).
    • Chronic hepatitis B: Long-term oral antiviral medications (main drugs: entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide) — intended to suppress the virus and slow the progression of liver disease.
  • Hepatitis C: Direct-acting antivirals (DAAs, e.g., sofosbuvir/velpatasvir and glecaprevir/pibrentasvir) — high cure rates (viral eradication) over a short period, usually 8–12 weeks.
• Autoimmune hepatitis: Corticosteroids (prednisone) ± immunosuppressants (mainly azathioprine).
• Toxic or drug-induced hepatitis: Stop the harmful drug; detoxification (e.g., N-acetylcysteine for acetaminophen poisoning) and supportive care as needed.
• Severe hepatitis or acute liver failure: Intensive care management, control of blood coagulation and intracranial pressure, and evaluation for liver transplantation if necessary.
• Lifestyle management and precautions
  • All patients with hepatitis must avoid alcohol. Avoid hepatotoxic supplements (certain herbal medicines and nutritional supplements).
  • Consult medical staff before taking prescription or over-the-counter medicines (due to the risk of interactions and toxicity involving drugs metabolized by the liver).
  • Weight management and a balanced diet are recommended (avoid excessive fat). Avoid rapid weight loss.
  • If acute or severe symptoms (changes in consciousness, bleeding, rapidly worsening jaundice, etc.) occur, visit an emergency room immediately.

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

• Items to bring (if available)
  • A list of all medications and supplements currently being taken (including doses and duration of use), or the actual medication packages
  • Copies of previous test results (blood test values, ultrasound, liver fibrosis and elastography results, etc.)
  • Past medical history (liver disease, blood disorders, autoimmune diseases, history of blood transfusions and injection treatments) and family history
  • A note recording the date symptoms began and their progression (jaundice, changes in urine or stool color, fever, degree of fatigue, etc.)
  • Records of alcohol consumption (average weekly/daily amount) and weight changes
• Key information to tell the doctor during the outpatient visit
  • Date symptoms began, factors that worsened or improved them, and any recent travel, meals, blood transfusions, or acupuncture procedures
  • Vaccination history (especially hepatitis A and B) and previous hepatitis test results
• Expected tests: Liver function tests (ALT/AST, bilirubin, albumin, INR), serum viral tests (HAV IgM, HBsAg, anti-HBc, HBV DNA, anti-HCV, HCV RNA), abdominal ultrasound, and, if necessary, liver biopsy or elastography.

Examples of General Questions to Ask the Doctor

• "What is causing my hepatitis, and is there currently an active virus?"
• "What treatment options are currently recommended, and what is the expected treatment duration?"
• "What are the side effects of the prescribed medication, and what precautions should I take while taking it?"
• "What prognosis can be expected with treatment, and what is the long-term follow-up plan (frequency of testing)?"
• "What should I be careful about in daily life (exercise, food, alcohol, and travel)?"

Examples of Disease-Specific Questions

• Regarding viral hepatitis (e.g., hepatitis B or C):
  • "Based on my blood test results (viral load and markers), please tell me about the risk of chronic infection and the degree of infectivity. How high is the risk of transmission to my family?"
  • "If I have chronic hepatitis B (or C), when should treatment begin, and how often should tests be performed during and after treatment (e.g., HBV DNA/HCV RNA and liver fibrosis assessment)?"
• Regarding autoimmune or drug-induced hepatitis:
  • "If I have autoimmune hepatitis, what is the expected duration of steroid and immunosuppressant treatment, and what side effects should be monitored?"
  • "Does the OOO I am currently taking (drug name) affect the liver, and is there a safe alternative medication?"

Additional guidance: If severe symptoms (changes in consciousness, bleeding, rapid progression of jaundice, worsening ascites or abdominal pain, etc.) occur, visit an emergency medical facility without delay. Prevention (e.g., hepatitis A and B vaccination, safe injection practices and prevention of sexually transmitted infections, and hygienic drinking water and food) is also essential to hepatitis management.