Symptoms of Acute Viral Hepatitis

Fatigue is a common initial symptom of viral hepatitis.. Photo: C. Leconte/stock.xchng

Hepatitis is a disease of the liver and to really understand the signs and symptoms of hepatitis requires a basic knowledge of what the liver does. For now, you must understand that the liver is crucial to the body because it is involved in many functions essential to life.

For example, did you know that 25% of your blood volume goes through your liver every minute? So every five minutes, your liver filters your entire blood supply.

Because the liver intersects so many different body systems, signs and symptoms of liver disease often resemble many different diseases. Certainly, when the liver is having problems, the body lets you know in many different ways.

Four Important Principles

Before we go through the symptoms of viral hepatitis, it's important to understand four general principles. These principles will help you make sense of the list of symptoms, which is really nothing but a guide. Symptoms are just a starting point. To make a diagnosis of acute viral hepatitis requires more than symptoms. In fact, doctors will use a variety of methods to make a diagnosis.

  • First, acute viral hepatitis usually have similar symptoms, regardless of the specific viral infection. This means that, in the acute stage, someone with hepatitis A could have the same symptoms as someone with hepatitis C. It is important to know that doctors can't diagnose the type of viral hepatitis infection through the symptoms. To find out if your viral hepatitis is caused by one of the hepatitis viruses, you need a blood test.
  • Second, the symptoms are general. Since the liver has a part in so many essential functions, many symptoms are constitutional, meaning they affect the entire body. For example, a sore leg will usually just hurt in and around the leg. With hepatitis, you may feel pain around the liver, but you will also probably have chills and aches in your joints and muscles.
  • Third, the symptoms are variable. Though doctors can list common symptoms of hepatitis, not everyone will have these symptoms. Some people may have only one or two common symptoms. Others may have all of the symptoms. People experience viral hepatitis in different ways. These symptoms are known to exist in people with viral hepatitis. Your situation might be different.
  • Fourth, many times acute viral hepatitis will have no symptoms at all. Isn't this bizarre? But it's true! Depending on how your body responds to the initial infection, you might have no symptoms. In fact, some people only find out they had (or have) hepatitis after donating their blood or maybe during routine blood work during an annual physical examination. The word doctors use to describe a person with no symptoms is "asymptomatic." You still had the infection, but your body didn't need to tell you about it.

Symptoms of Acute Viral Hepatitis

Though symptoms of hepatitis can be organized in several ways, a good approach is by dividing the symptoms into three stages which progress with the disease -- beginning, middle and recovery.

Each of these stages match up with a specific clinical term that doctors use to describe viral hepatitis.

Beginning Symptoms (Prodromal Stage)

The initial symptoms of hepatitis, or prodromal symptoms, can happen suddenly or they can happen slowly and subtlely. These symptoms are usually so general that most people wouldn't expect viral hepatitis. However, a good physician will want to rule out viral hepatitis especially if you have risk factors that increase your exposure to viral hepatitis.

Symptoms begin after the incubation period, which is specific to the particular virus causing the infection. Once you are exposed to the virus, the virus needs time to replicate. Once enough copies of the virus have infected the hepatocytes of the liver, your body's immune system responds with powerful anti-viral cells that seek and destroy the hepatitis viruses. It's very interesting that part of the symptoms you experience from acute viral hepatitis is actually caused by your body's immune system defense. Remember, you may have some of these prodromal symptoms, all of these, or none of these. Everyone could experience viral hepatitis a little bit differently. Eventually, though, you'll progress to the second stage of symptoms: the Middle.

To read about symptoms of viral hepatitis during the middle and recovery stages, please continue to page two.

Middle Symptoms (Icteric or Jaundice Stage)

About 5 to 10 days after the prodromal stage begins, the initial symptoms may worsen and sometimes, jaundice may develop. However, while jaundice is the most well-known sign of hepatitis, it's actually a symptom that few people have. Jaundice, which is an accumulation of a chemical called bilirubin in the body's tissues, can give a yellow color to the skin, urine and especially around the whites of the eyes. In addition, people with jaundice may have light-colored stools.

The liver usually processes bilirubin as a waste product. When the liver is damaged, by the hepatitis viruses for example, it's unable to do its normal job and things start to go wrong. Bilirubin builds up in the blood and starts to leak out into nearby tissues. When enough of this chemical accumulates, the person appears jaundiced.

Some people won't realize they have acute viral hepatitis until they (or their friends) notice their yellow tint. This leads them to the doctor's office where blood work follows. But as noted above, jaundice isn't a reliable way to diagnose viral hepatitis because many people with viral hepatitis never have it. Also, other diseases can cause jaundice.

Recovery (Convalescent Stage)

During the recovery stage, the symptoms will disappear, probably following the order in which they came. You'll start to get your appetite back and your energy levels will start returning to what they were before you got sick. If you had jaundice, that too, will start to fade as your liver is able to better process the bilirubin in your blood. For those with hepatitis A and E, complete recovery should be expected by two months, if not sooner. For those with hepatitis B and C, full recovery should be expected by four months in the majority of people with uncomplicated infections.

Coinfection or superinfection with hepatitis D is considered a complication and the recovery time may be longer. Also, recovery times after infection with hepatitis B and C can be very different for people with HIV.

For more information about the five viruses that target the liver and cause viral hepatitis infection:

Some people won't get to the recovery stage. For people with acute viral hepatitis, they will either have no symptoms (asymptomatic) or they will have the symptoms described above and in my Big List of Acute Viral Hepatitis Symptoms. Normally, most people get better. However, for some, their bodies won't be able clear the infection and they will transition to chronic viral hepatitis. This would be your diagnosis if you still had evidence of hepatitis virus in your liver after six months of infection.

Chronic infection will present with different signs and symptoms.


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