Hepatitis: Difference between revisions

Hepatitis has a broad spectrum of presentations that range from a complete lack of symptoms to severe&nbsp;[[liver failure]].<ref name="Harrison's Principles, chapter 360 (Acute Viral)">{{Cite book|title=Harrison's Principles of Internal Medicine, 19e|last=Dienstag|first=JL|publisher=McGraw-Hill|year=2015|isbn=978-0-07-180215-4|editor-last=Kasper|editor-first=D|location=New York, NY|chapter=Chapter 360: Acute Viral Hepatitis|editor-last2=Fauci|editor-first2=A|editor-last3=Hauser|editor-first3=S|editor-last4=Longo|editor-first4=D|editor-last5=Jameson|editor-first5=J|editor-last6=Loscalzo|editor-first6=J}}</ref><ref name="CURRENT Diagnosis & Treatment">{{Cite book|title=CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e|last1=Rutherford|first1=A|last2=Dienstag|first2=JL|publisher=McGraw-Hill|year=2016|isbn=978-0-07-183772-9|editor-last=Greenberger|editor-first=NJ|location=New York, NY|chapter=Chapter 40: Viral Hepatitis|editor-last2=Blumberg|editor-first2=RS|editor-last3=Burakoff|editor-first3=R}}</ref><ref name="Khalili & Burman">{{Cite book|title=Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e|last1=Khalili|first1=M|last2=Burman|first2=B|publisher=McGraw-Hill|year=2013|isbn=978-1-25-925144-3|editor-last=Hammer|editor-first=GD|chapter=Chapter 14: Liver Disease|editor-last2=McPhee|editor-first2=SJ}}</ref> The acute form of hepatitis, generally caused by viral infection, is characterized by&nbsp;[[constitutional symptoms]]&nbsp;that are typically self-limiting.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /><ref name="CURRENT Diagnosis & Treatment" /> Chronic hepatitis presents similarly, but can manifest [[medical sign|signs]] and symptoms specific to liver dysfunction with long-standing inflammation and damage to the organ.<ref name="Khalili & Burman" /><ref name="Harrison's Principles, chapter 362 (Chronic)">{{Cite book|title=Harrison's Principles of Internal Medicine, 19e|last=Dienstag|first=JL|publisher=McGraw-Hill|year=2015|isbn=978-0-07-180215-4|editor-last=Kasper|editor-first=D|location=New York, NY|chapter=Chapter 362: Chronic Hepatitis|editor-last2=Fauci|editor-first2=A|editor-last3=Hauser|editor-first3=S|editor-last4=Longo|editor-first4=D|editor-last5=Jameson|editor-first5=J|editor-last6=Loscalzo|editor-first6=J}}</ref>

 

Acute viral hepatitis follows three distinct phases:

# The initial [[Prodrome|prodromal phase]] (preceding symptoms) involves [[non-specific]] and [[flu-like]] symptoms common to many acute viral infections. These include [[Fatigue (medical)|fatigue]], [[nausea]], [[vomiting]], poor appetite, joint pain, and headaches.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /><ref name="CURRENT Diagnosis & Treatment" /> Fever, when present, is most common in cases of hepatitis A and E.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /> Late in this phase, people can experience liver-specific symptoms, including [[choluria]] (dark urine) and clay-colored stools.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /><ref name="CURRENT Diagnosis & Treatment" />

# [[Jaundice|Yellowing of the skin and whites of the eyes]] follow the prodrome after about 1–2 weeks and can last for up to 4 weeks.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /><ref name="CURRENT Diagnosis & Treatment" /> The non-specific symptoms seen in the prodromal typically resolve by this time, but people will develop an [[hepatomegaly|enlarged liver]] and right upper abdominal pain or discomfort.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /> 10–20% of people will also experience an [[Splenomegaly|enlarged spleen]], while some people will also experience a mild unintentional weight loss.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /><ref name="Khalili & Burman" />

# The recovery phase is characterized by resolution of the clinical symptoms of hepatitis with persistent elevations in [[Liver function tests|liver lab values]] and potentially a persistently enlarged liver.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /> All cases of hepatitis A and E are expected to fully resolve after 1–2 months.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /> Most hepatitis B cases are also self-limiting and will resolve in 3–4 months. Few cases of hepatitis C will resolve completely.<ref name="Harrison's Principles, chapter 360 (Acute Viral)" />

 

=== Fulminant hepatitis ===