Disease Description (Causes and Symptoms)
- Definition: Acute hepatitis caused by hepatitis A virus (HAV), which does not become chronic and usually resolves spontaneously.
- Cause and transmission: Mainly transmitted through the fecal–oral route. Infection occurs through contaminated food or water, or through the hands of patients (including asymptomatic carriers). HAV is relatively resistant in the environment and must be heated to a high temperature to be inactivated (e.g., it is destroyed when heated at 85°C for at least 1 minute).
- Pathophysiology: The virus, which enters through the intestinal mucosa, travels to the liver and infects hepatocytes. Immune responses cause hepatocellular injury, resulting in elevated ALT/AST levels, jaundice, and other symptoms.
- Main symptoms: Incubation period of 15–50 days (average approximately 4 weeks). Symptoms are more pronounced in adults.
- Early stage: Fatigue, loss of appetite, nausea and vomiting, fever, abdominal pain, diarrhea
- Jaundice stage: Yellowing of the eyes and skin, dark urine, pale stools, itching
- Asymptomatic infection or mild symptoms are common in children
- Characteristics: Does not progress to chronic hepatitis. Most people recover within several weeks to several months, but complications (e.g., acute liver failure) may occur in some cases.
Treatment Methods and Precautions
- Basic principles: Most cases are treated symptomatically and supportively (rest, fluid and nutritional supplementation, and symptom relief). Specific antiviral drugs are not standard treatment.
- Medications and management
- No alcohol: Completely abstain from alcohol until recovery (at least until liver enzyme levels return to normal).
- Avoid hepatotoxic medications: Do not take medications that may burden the liver, such as acetaminophen, without a doctor’s instructions.
- Get sufficient rest, maintain balanced nutrition, and drink adequate fluids.
- If itching is severe, symptomatic treatment with antihistamines, cholestyramine, or other medications may be considered (at the doctor’s discretion).
- Hospitalization criteria and management of severe cases
- Immediate hospitalization, intensive care, and evaluation for liver transplantation are required if liver failure is suspected, such as in cases of altered consciousness, a tendency to bleed, signs of acute kidney failure, rapid worsening of prothrombin time (PT/INR), or very high bilirubin levels.
- If acute liver failure (fulminant hepatic failure) develops, emergency liver transplantation may be necessary (mortality is high).
- Prevention and vaccination
- Post-exposure prevention: For contacts and exposed individuals, post-exposure prophylaxis with immunoglobulin (IG) or hepatitis A vaccine is recommended (vaccination or IG is preferably administered within 2 weeks after exposure — recommendations may vary by region and age; consult the treating doctor).
- Vaccination: Vaccination is recommended for children, adolescents, and non-immune adults (especially people in occupations or traveling situations with a high risk of infection).
- Precautions regarding complications
- Although rare, acute liver failure, relapsing hepatitis, cholestatic hepatitis, acute pancreatitis, kidney injury, and cytopenia have been reported.
- Precautions for self-management
- When symptomatic, do not prepare or cook food (especially because of the risk of transmission to others), practice thorough hand hygiene, and follow the isolation period instructed by your doctor.
- Regularly monitor liver function tests and changes in symptoms (keeping ongoing notes is recommended).
Checklist Before an Outpatient Visit (Including Examples of Items to Bring and Records to Keep)
- Documents and materials to bring
- A list of all medications, vitamins, and herbal medicines currently being taken (including doses and administration times)
- Recent test results (liver function tests (ALT/AST), bilirubin, PT/INR, etc.) and reports (include dates if possible)
- Vaccination history (especially whether you have received the hepatitis A vaccine) and whether you have recently received immunoglobulin
- Symptom-related records
- Date symptoms began (the first day each symptom, such as jaundice, nausea, or fever, occurred) and how the symptoms have progressed
- When changes in urine and stool color occurred (dark urine and pale stools)
- Changes in food intake and weight, and the frequency and duration of gastrointestinal symptoms (vomiting and diarrhea)
- Recent overseas travel, consumption of potentially contaminated food or water, and whether anyone in the same group (family, class, or workplace) has similar symptoms
- Example questions (prepare items to ask the doctor)
- Items to ask about in the tests: IgM anti-HAV, liver enzyme levels, criteria for emergency hospitalization, etc.
- Interval between follow-up tests and how recovery will be confirmed
Examples of General Questions to Ask the Doctor
- "What are the side effects of this medication (or the medication you plan to prescribe)? Will it harm my liver?"
- "At what levels of my liver tests (ALT/AST, bilirubin, and INR) would hospitalization be necessary?"
- "How long will I be at risk of transmitting the infection to others? When can I return to normal activities (work or school)?"
- "I have not been vaccinated yet. Should I recommend vaccination to my family? What measures should be taken for contacts?"
Examples of Disease-Specific Questions
- "How should I interpret the IgM anti-HAV and liver enzyme levels (specific values) in my test results? Please tell me what stage of the current infection I am in."
- "A case of hepatitis A recently occurred in the same group (family/household/workplace). What post-exposure preventive measures (vaccine or immunoglobulin) should my cohabitants and I take now? By when are they recommended?"