What are the signs and symptoms of viral hepatitis?

Signs and Symptoms of Viral Hepatitis

Viral hepatitis presents with a spectrum of clinical manifestations ranging from asymptomatic infection to acute liver failure, with symptoms varying by virus type, patient age, and underlying health status.

Common Clinical Presentations

• Prodromal phase: Characterized by influenza-like symptoms including fever, fatigue, anorexia, nausea, vomiting, and abdominal discomfort lasting 1-7 days 1, 2
• Jaundice phase: Develops after the prodromal phase with yellowing of skin and mucous membranes, dark urine, and clay-colored stools 1, 2
• Asymptomatic infection: Approximately 75% of acute hepatitis A infections and 60-80% of chronic HCV infections are asymptomatic 1, 3
• Abdominal pain: Particularly in the right upper quadrant, often accompanied by hepatomegaly 4, 2
• Pruritus (itching): May develop within 2-12 weeks of infection, particularly in HCV infection 1

Specific Signs by Hepatitis Type

Hepatitis A

• Acute onset: Abrupt onset of symptoms with jaundice occurring within a few days to a week after prodromal symptoms 3
• Self-limited course: Symptoms typically resolve within 2-4 weeks with complete recovery in most cases 5, 3
• Dark urine: Often one of the first noticeable symptoms 5
• Rare manifestations: Maculopapular rash and polyarthralgia in some cases 6

Hepatitis B and C

• Chronic infection: Often asymptomatic but can cause persistent liver injury leading to cirrhosis and hepatocellular carcinoma 1
• Extrahepatic manifestations: Include arthritis, skin rash, and cryoglobulinemic vasculitis, particularly in HCV 1
• Laboratory findings: Steady or intermittent elevation of serum ALT in 60-70% of chronic HCV patients 1

Hepatitis E

• Acute hepatitis: Similar to HAV but tends to affect older males (median age 63 years) in developed countries 1
• Severe course in specific populations: More severe in pregnant women, elderly patients, and those with underlying liver disease 1

Laboratory Findings

• Elevated liver enzymes: Marked increase in serum ALT and AST levels, often reaching several thousand units in acute cases 1
• Hyperbilirubinemia: Serum bilirubin levels typically below 3-8 mg/dL in acute HCV infection 1
• Hyperglobulinemia: Common in autoimmune hepatitis but can be seen in viral hepatitis as well 1

Progression and Complications

• Acute liver failure: Rare complication (<1% in HCV) but can occur, particularly in elderly patients and those with underlying liver disease 1
• Chronic infection: Occurs in 54-85% of acute HCV infections, 15-45% of HBV infections, but not in HAV or HEV (in immunocompetent hosts) 1
• Cirrhosis: Develops in 15-56% of chronic HCV patients over 20-25 years 1
• Hepatocellular carcinoma: Annual incidence of 1-4.9% in HCV patients with cirrhosis 1

Special Considerations

• Pregnancy: Viral hepatitis in pregnancy is associated with adverse maternal and neonatal outcomes including small-for-gestational-age infants and low birthweight 1
• Elderly patients: More likely to develop symptomatic disease and complications 1, 5
• Patients with underlying liver disease: At higher risk for acute-on-chronic liver failure and severe outcomes 1

Monitoring Parameters

• Liver function tests: Monitor ALT, AST, bilirubin, and INR, particularly in patients with jaundice 4
• Signs of liver failure: Watch for prolonged INR and hepatic encephalopathy 4
• Hydration status: Monitor for dehydration due to nausea and vomiting 4

Remember that viral hepatitis can present with varying severity, from subclinical to severe acute disease, and may progress to chronic infection depending on the virus type and host factors 7.