For professionals:

Clinical features:

• 1. Patients with chronic hepatitis usually present with no specific clinical symptoms, therefore, frequently overlooked in clinical practice, and sometimes found only when having already progressed to cirrhotic stage.

• 2. Even in cirrhotic stage, there is still no any clinical symptom noted.

• 3. Rather common symptoms are malaise and fatigue, sometimes there are nausea, epigastralgia, arthralgia, or muscle pain.

• 4. In case of acute exacerbation (flare-up), there will be of symptoms like those of acute hepatitis.

• 5. Jaundice and anorexia rarely occur except during acute exacerbation.
• 6. Signs of portal hypertension: splenomegaly, esophageal varicies, thrombocytopenia, anemia, leucopenia etc.
• 7. Hepatomegaly usually present in chronic hepatitis, however, liver size decreases along with progression into cirrhosis.
• 8. Splenomegaly is present in cirrhotic stage.
• 9. Spider angiomata (nevi), palmer erythema, engorgement of superficial veins of the abdomen and thorax, gynecomastia.
• 10. Bleeding tendency (Purpura: ecchymosis, petechiae, suggilation)
• 11. Encephalopathy (drowsiness, tremor, asterixis, dysarthrias, delirium, coma)

• 1. Repeated laboratory tests are needed for the diagnosis of chronic hepatitis.
• 2. Serum ALT, AST usually show different degree of elevation, however, they may be within normal ranges. In cirrhotic stage, usually the AST is greater than ALT.
• 3. Normal value does not mean that the hepatitis is inactive, and the degree of elevation dose not parallel to the severity of histological activity of chronic hepatitis.
• 4. Serum gamma-GT and Alk-P-tase are usually within normal range or mildly elevated except for in acute episode and cirrhosis.
• 5. Serum bilirubin, albumin, and Pro-T are also usually within normal range or only slightly elevated except for in severe case.
• 6. Serum gamma-globulin and immunoglobulin-G show mild to moderate degree of elevation, and in the case of autoimmune hepatitis it is usually highly elevated, and it is higher in hepatitis C than hepatitis B.
• Thrombocytopenia is present in cirrhotic stage. On shunt procedure or splenectomy, the throbocytopenia does not always recover. Decrease in production of throbopoietin of the liver was noted in cirrhois, therefore, throbocytopenia in cirrhosis is partly attributable to reduction in thrombopoietin production by the liver.