Symptoms of Hepatitis

sick woman with fever taking temperature
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The symptoms of viral hepatitis (broadly defined as inflammation of the liver caused by infection of one of five specific hepatitis viruses), can be confounding, ranging from none at all or mild, short-lived flu-like symptoms (in the case of acute viral infections) to more classic ones.

Typically, when the symptoms of hepatitis are obvious the infection has progressed from an acute infection to chronic disease and liver damage. Serious liver damage can, in turn, have dire and even life-threatening complications such as cirrhosis and cancer.

Symptoms

Symptoms of acute viral hepatitis, if they occur, will begin to appear during the prodromal stage of infection, when the virus has begun to aggressively replicate and spread to the cells of the liver (called hepatocytes).

In order to defend against the virus, the immune system will set off an inflammatory response that can bring on symptoms similar to those of seasonal flu, accompanied by signs more suggestive of a gastrointestinal or liver-related infection, including:

  • General tiredness or fatigue
  • Muscle pain (myalgia)
  • Joint pain (arthralgia)
  • Headache
  • Fever
  • Nausea
  • Vomiting
  • Loss of appetite
  • Pain in the upper right part of the abdomen (generally mild but constant)
  • Red, raised hives (most commonly seen with hepatitis B)
  • Changes in the way things taste or smell (smokers will often develop a sudden distaste for cigarettes)

Within several days of these early signs, the infection will trigger the build-up of bilirubin, an orange-yellow pigment produced when the liver breaks down old red blood cells. This compound can rapidly accumulate in the body, causing tell-tale signs of hepatitis:

  • Jaundice (yellowing of skin and whites of the eyes)
  • Choluria (darkening of urine)
  • Pale or clay-colored stools

Symptoms of acute viral hepatitis rarely become severe. However, fatigue can persist for weeks and, in some cases, even months. In most cases, acute symptoms resolve in about four to eight weeks. (One exception is hepatitis D, in which acute liver damage is more common.)

Complications

When the hepatitis virus does not spontaneously clear but instead continues to replicate, the infection is said to be chronic. Depending on the type of hepatitis virus, a chronic infection can persist for years or decades before signs of illness are evident. In fact, by the time chronic hepatitis is evident the symptoms that occur are those of complications from the infection.

Cirrhosis

When hepatocytes are injured during chronic infection, an inflammatory response will take place, stimulating the production of collagen and other substances that begin to build up faster than the body can break them down. Over time, the process causes the progressive accumulation of scar tissue, known as fibrosis.

Fibrosis tends to progress more rapidly in men than in women as well as in people over 50 or those who drink heavily or are obese. In some cases, it can remain stable or even regress over time.

Fibrosis can lead to a complication called cirrhosis—scarring so extensive as to restrict the liver’s blood supply and disrupt normal function. Cirrhosis symptoms can vary, depending on the stage of progression.

There are two classifications of liver cirrhosis, compensated and decompensated.

Compensated cirrhosis, in which the liver has minimal to moderate damage, tends to have few, if any, symptoms. Possible signs include:

  • Persistent malaise or fatigue
  • Discomfort in the upper right part of the abdomen
  • Nausea
  • Joint or muscle pain
  • An abnormal tingling or burning sensation (paresthesia)
  • An uncomfortable "pins-and-needles" sensation (peripheral neuropathy)
  • Dry eyes accompanied by dry mouth (sicca syndrome)
  • Spider veins, mainly on the trunk and face
  • Itchy skin (pruritus)
  • Redness on the palms of the hands (palmar erythema)
  • Easy bruising or abnormal bleeding (variceal bleeding)
  • A build-up of fluid in the ankles and feet (edema)
  • Poor concentration and memory
  • Loss of appetite
  • Weight loss
  • Shrinking testicles (testicular atrophy)
  • Erectile dysfunction or loss of libido
  • Alcohol intolerance.

Decompensated cirrhosis is diagnosed if damage is extensive and the liver is non-functioning. The symptoms are the result of liver failure and include:

  • Jaundice
  • Tarry or bloody stools
  • Accumulation of fluid in the abdominal cavity, causing swelling and distention (ascites)
  • A distinctive "sweet-musty" to "rotten egg" breath odor
  • Extreme bruising or bleeding
  • Abnormally decreased urine output
  • Personality changes, confusion, or tremors
  • Increased sleepiness
  • Muscle wasting
  • White discoloration or "milk spots" on the nails (leukonychia)
  • Vomiting of blood

Decompensated cirrhosis is classified as end-stage liver disease. Liver transplantation is considered the only viable option for treatment.

Hepatocellular carcinoma (HCC)

This is a type of liver cancer that develops almost exclusively in association with cirrhosis in patients with hepatitis B or hepatitis C. The symptoms of HCC are similar to those of decompensated cirrhosis:

  • Persistent fatigue
  • Jaundice
  • Accumulation of fluid in the abdominal cavity (ascites)
  • Abnormal bruising and bleeding
  • Unintentional, extreme weight loss
  • Loss of appetite
  • Feeling full after only eating a small amount
  • Delirium, confusion, or coarse "jerking" muscle movements

Like decompensated cirrhosis, HCC is considered an end-stage liver disease.

When to See a Doctor

If you develop any of the symptoms of chronic hepatitis, liver damage, or liver cancer, see your doctor. It takes only a blood test to detect the presence of a hepatitis virus in your body (or antibodies that indicate your immune system has been attempting to fight off such a virus).

A blood test also can determine which hepatitis virus you're infected with, which will determine what your treatment should be (usually an antiviral medication that may not clear the virus from your body, but may prevent it from replicating).

A Word From Verywell

The symptoms of viral hepatitis are very similar even though different viruses cause the disease. Because of this, it is not possible to accurately diagnose the type of virus causing viral hepatitis just by the symptoms.

By identifying risk factors (behaviors or traits that put you at extra risk for a certain disease) and getting a good medical history, doctors can come up with a strong working diagnosis. Since common symptoms overlap with many diseases, though, blood tests are necessary to diagnose viral hepatitis.​

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