An Overview of Hepatitis Symptoms

One of the most confounding things about a hepatitis infection—specifically a viral hepatitis infection—is that symptoms can range from everything from a short-term, flu-like illness to a slowly progressive, life-threatening condition. In fact, in many cases, there will be no signs or symptoms of any sort, with the virus spontaneously clearing from the body with no evidence (or even awareness) that an infection had taken place.

However, in those who do experience symptoms of hepatitis, there are some which may be considered "classic," particularly in the very early and late stages of infection. To better understand the reasons for this, we first need to differentiate between a so-called acute infection and a more long-term chronic infection.

Acute Hepatitis Symptoms

Within the scope of viral hepatitis, an acute infection can be defined as one which it is self-limiting. It begins suddenly as result of the body’s response to the virus and will typically resolve on its own.

The symptoms of acute hepatitis, when present, will first begin to appear just after the incubation during the prodromal stage—when the virus has begun to aggressively replicate and spread to the cells of the liver (called hepatocytes). In mounting an immune defense, the body will undergo an inflammatory response in order to neutralize the virus. This response, often robust, can manifest with symptoms similar to that of the 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—during what is called the ischemic stage—the on-going infection will trigger a build-up of a compound called bilirubin. Bilirubin is an orange-yellow pigment that is produced when the liver breaks down old red blood cells, which is then secreted through digestive bile in feces (stools).

During an acute hepatitis infection, bilirubin can rapidly accumulate in the body, manifesting with such "tell-tale" signs of hepatitis as:

  • Jaundice (the yellowing of the skin and eyes)
  • Choluria (the darkening of urine, caused by excess of bile in urine)
  • Pale or clay-colored stools (caused by a reduction of bile in feces)

Rarely do symptoms become extremely severe (with, perhaps, the exception of hepatitis D in which acute liver damage is more common), although exhaustion can persist for weeks and, in some cases, even months. In most cases, however, acute symptoms resolve in about four to eight weeks.

In some forms of viral hepatitis, namely hepatitis A, symptoms will not generally progress beyond the acute stage. In other types, however, an acute infection will either spontaneously clear, leaving no genetic traces of virus anywhere, or persist into what we call a chronic infection.

Chronic Hepatitis Symptoms

A chronic hepatitis infection is one in which the virus does not spontaneously clear but instead continues to replicate, often "silently" without a person even knowing. Depending on the viral type, a chronic infection can persist for years and even decades before any signs of illness are evident. In many cases, the disease will never progress.

When hepatocytes are injured during a chronic infection, the immune system will trigger an inflammatory response which stimulates the production of collagen and other substances. These substances, which are meant to strengthen the internal architecture of the liver, gradually 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 does not advance at the same rate in all people, and, in some cases, can remain stable or even regress over time. Fibrosis tends to progress more rapidly in men than in women as well as in people over the age of 50 or those who drink heavily or are obese.

In some, fibrosis can advance to a condition called cirrhosis, in which scarring is so extensive as to restrict the liver’s blood supply, thereby disturbing normal function. Cirrhosis symptoms can vary, depending on the stage of progression. In cases where the liver is still functional with minimal to moderate damage, the disease will be classified as compensated cirrhosis. If the damage is extensive and the liver is considered non-functioning, a doctor will describe this as decompensated cirrhosis.

Compensated cirrhosis tends to manifest with few, if any, symptoms. If present, they are rarely incapacitating and often difficult to ascribe to liver disease alone. 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)
  • 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, by contrast, typically presents with a wide range of symptoms as the result of liver failure, worsening as the disease progresses. Symptoms can 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 an end-stage liver disease. Liver transplantation is considered the only viable option for treatment.

Hepatocellular carcinoma (HCC) 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 and can include:

  • 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 also considered an end-stage liver disease.


National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Viral Hepatitis: A through E and Beyond." Bethesda, Maryland; August 20, 2016.

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