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(Key words: acut viral hepatitis, symptom, clinical feature)

• Typical course:

  Regardless of the type, a typical case may go through the symptoms of the following four stages, however, not all the cases may have all these symptoms, even there are many cases without any of these symtoms.

  1. Incubation stage
  2. Pre-icteric stage
  3. Icteric stage
  4. Convalescent stage
  • Incubation stage: No symptoms and signs

  • Pre-icteric stage: (prodromal symptoms)
    1. Flu-like symptoms, malaise, nausea, muscle ache, headache, fever.
    2. RUQ pain ( several days to two weeks before appearance of jaundice).
    3. Dark discoloration of urine.

  • Icteric stage:
    1. Jaundice of sclera and skin. Itching.
    2. Clay-color stool (cholestatic hepatitis)
    3. There are many cases with only the flu-like symoptoms and no apparent jaundice, therefore, usually misdiagnosed as cold or flu without biochemical test of blood for hepatitis.
       • These cases may show marked elevation of serum transaminase due to necrosis of hepatocytes when blood test was done.

       • Only one in nine cases of acute type A hepatitis had jaundice in our study.

       • Degree of jaundice (icterus): differs case by case.

       • Type B, C, and D hepatitis may progress to chronic hepatitis regardless of the presence of jaundice or not.
  • Convalescent stage:

• Diagnosis:
  1. Impossible to make differential diagnosis of the types by clinical syptoms.

  2. Precise history of :
     Contact with hepatitis patients, recent travel history, injection, tattooing, dental surgery, blood transfusion, homosexual behavior, intake of raw seafood like oyster, intravenous drug use, and occupation.

  3. Physical examination:
  4. Biochemical test including hepatitis markers for viral hepatitis.

• Course and prognosis:
  differ from case to case:
  1. cases unaware of the infection and cure naturally,
  2. cases with symptoms, typical course and cure,
  3. cases with severe symptoms accompanied by coma and cure,
  4. cases end up with fatal outcome.
  • During icteric stage:

    70 % of the cases will accompanied by hepatomegaly, and 20 % by splenomegaly.
    Actually, it is very difficult to detect hepatomegaly and/or splenomegaly at bedside. (because of body build and rather soft liver)

  • Blood biochemical changes will recover to normal within six weeks.

  • Usually, the prodromal symptoms subside when the jaundice become apparent.

  • Extra-hepatic symptoms and signs:
    arthralgia, arhtrits, urticaria, purpura, angioneurotic edema, myocarditis, pancreatitis.

  • Type B, D, and C acute hepatitis may progress further to chronic hepatitis, cirrhosis and hepatocellular carcinoma.

  Atypical types:
  • Cholestatic hepatitis:
    • Jaundice becomes severe day by day after onset.
    • Pruritus appears three weeks after onset.
    • Jaundice may persist for 8 ~ 29 weeks.
    • Finally, recover completely.

  • Relapsing hepatitis:
    • Occur in 1.8 ~ 15 % of type A hepatitis cases.
    • Usually, occur due to early return to labor work or alcohol intake.
    • Usually, will cure, but some cases will develop to chronic cases.
    • The use of steroids in the acute type B hepatitis will cause progression to chronic hepatitis.

  • Fulminant hepatitis:
    • 1 ~ 2 % od acute hepatitis cases may fall into hepatic coma and followed by death (40~70%) (acute hepatic failure).
    • Recovery will be complete.
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  (By Jau-Shin Wu, M.D.; Posted Sep. 16, 1996; Revised May 12, 2009)
  (TMN) Since June 09, 2002
  
  (Dr. Wu's Liver D) Since Jan. 01, 2008
  (Olddoc)Since Jan. 01, 2008
  (TMN) Since Jan. 01, 2008