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According to the different infecting viruses:
Hepatitis A
Caused by infection with the hepatitis A virus, primarily transmitted through the fecal-oral route, with an incubation period of 2 to 6 days, and mostly seen in adolescents and children.
Hepatitis B
Caused by infection with the hepatitis B virus, primarily transmitted through blood, mother-to-child transmission, and sexual contact, with an incubation period of 1 to 6 months.
Hepatitis C
Caused by infection with the hepatitis C virus, transmitted through blood, mother-to-child transmission, and sexual contact, with an incubation period of 1 to 6 months.
Hepatitis D
Caused by infection with the hepatitis D virus, does not cause infection on its own and requires the presence of hepatitis B virus for transmission, mainly transmitted through blood, with an incubation period of 1 to 6 months.
Hepatitis E
Caused by infection with the hepatitis E virus, primarily transmitted through the fecal-oral route, with an incubation period of 2 to 8 weeks, and mostly seen in children and adults.
According to the course of viral hepatitis:
Viral hepatitis can be divided into acute hepatitis and chronic hepatitis.
According to the clinical manifestations of viral hepatitis:
Viral hepatitis can be classified as severe hepatitis, hepatitis cirrhosis, obstructive jaundice hepatitis, etc.
Hepatitis A and E viruses
Fecal-oral transmission: Patients ingest or come into contact with water, food, toys, and other items contaminated with hepatitis A or E virus, leading to infection.
Hepatitis B, C, D
Blood transmission: Virus-containing blood enters the body through transfusions, blood dialysis, organ transplants, syringes, surgeries, needle pricks, shared razors, etc., leading to viral infection.
Sexual transmission: Semen and vaginal secretions of hepatitis patients also contain viruses, and unprotected sexual contact can lead to infection.
Mother-to-child transmission: The virus can be transmitted from the mother to the fetus through the placenta, known as intrauterine infection. In the period before and after delivery, the baby's skin or mucous membranes may come into contact with the mother's blood, amniotic fluid, and secretions, leading to infection, known as perinatal transmission. Close contact between the mother and baby after delivery can also lead to infection, known as postpartum transmission.
General symptoms
Patients may experience fatigue, weakness, loss of appetite, and itchy skin.
Liver area symptoms
Patients may experience liver area pain, liver enlargement, and tenderness when pressing or tapping the liver.
Digestive system symptoms
Patients may experience abdominal distention, nausea, vomiting, aversion to oily foods, and upper abdominal discomfort. As the disease progresses, patients may develop ascites, esophageal variceal bleeding, and other symptoms.
Jaundice symptoms
Patients may experience darkening of urine, yellowing of the skin and the whites of the eyes, and lightening of stool color.
Other characteristic changes
Liver palms: Due to liver function abnormalities, the skin on the sides of the hand may show congestion or red patches.
Spider nevi: Small blood vessels at the end of the skin branches expand radially, resembling spiders. When pressure is applied to the central area of liver palms or spider nevi, the congestion may temporarily disappear but reappear when the pressure is released.
Neurological symptoms
These are generally seen in patients with poorly controlled conditions or rapidly progressing diseases, where patients may experience neurological dysfunction.
Treatment during the acute phase of viral hepatitis includes urgent management in cases of severe symptoms, such as gastrointestinal bleeding. For example, in cases of esophageal variceal bleeding, prompt administration of vasoactive drugs such as terlipressin, somatostatin, octreotide, vasopressin, etc., is recommended. In cases where these are ineffective, endoscopic therapy involving ligation and sclerosant injection can be performed, or alternatively, a transjugular intrahepatic portosystemic shunt (TIPS) procedure can be carried out to reduce vascular pressure and stop bleeding using balloon tamponade.
As for medication treatment for viral hepatitis, it's important to note that there is no absolute "best," "fastest," or "most effective" medication, and medication choices should be made in consultation with a doctor. Antiviral therapy can help inhibit virus replication, reduce infectivity, improve liver function, alleviate liver damage, delay or reduce the occurrence of liver cirrhosis, liver failure, and hepatocellular carcinoma, and extend survival time. The decision to undergo antiviral therapy should be made based on a comprehensive assessment of the patient's condition.
Interferon can be used for the treatment of chronic hepatitis B and C, but it is not suitable for patients with serum bilirubin levels more than twice the normal value, decompensated cirrhosis, autoimmune diseases, significant organ damage, and women of childbearing age. After using interferon, patients may experience bone marrow suppression, leading to reduced platelets and granulocytes, as well as psychiatric and neurological symptoms. Close observation, dose reduction, or discontinuation may be necessary based on the patient's condition.
Nucleoside analogs are only used for the treatment of hepatitis B. These drugs include lamivudine, entecavir, tenofovir, telbivudine, adefovir dipivoxil, besifovir, tenofovir alafenamide, and emtricitabine. Biochemical indicators such as ALT, AST, and bilirubin, as well as virological markers, need to be monitored before and during treatment, with at least 12 months of follow-up after discontinuation. Entecavir, tenofovir, and tenofovir alafenamide are first-line treatment drugs.
Direct-acting antiviral drugs (DAA) can be used for the treatment of hepatitis C. Drugs in this category include sofosbuvir, daclatasvir, etc. Different drugs or drug combinations can be chosen based on the different genotypes of hepatitis C virus, with a typical treatment duration of 12 or 24 weeks.
In addition, doctors may also consider anti-inflammatory, antioxidant, liver protection, anti-fibrotic, and immune-regulating therapies based on the patient's condition.
For daily life management of viral hepatitis, it is recommended to maintain a balanced and healthy diet, avoid excessive alcohol consumption, engage in moderate exercise to enhance resistance, and maintain a healthy lifestyle. Psychological well-being is also important, and patients should strive to maintain a positive mindset and seek support from healthcare professionals or family members if needed.
In terms of prevention, it's important to control sources of infection. Acute patients should be isolated and treated until the virus disappears, while chronic patients and carriers should undergo evaluation of infectiousness and, if suitable, receive antiviral therapy. Infected individuals should not engage in food processing, catering, or childcare work.
To prevent the spread of hepatitis A and E, proper management of feces and sanitation of food and water are essential. For hepatitis B, C, and D, which primarily spread through blood, mother-to-child transmission, and sexual contact, the use of disposable syringes is encouraged, and all medical instruments should undergo strict disinfection. Good personal hygiene habits, such as not sharing items like toothbrushes and razors, are also recommended.
Lastly, it's important to protect vulnerable populations from exposure to acute hepatitis patients, and vaccination is recommended for women, children, the elderly, and other susceptible individuals.
