The symptoms of hepatitis can range from relatively mild to loss of life. Before symptoms of illness begin, a person may have a severe loss of appetite. A distaste for cigarettes is also an early sign. The patient may also experience a general feeling of being unwell, nausea, vomiting and often fever. Sometimes, especially in hepatitis B, hives and joint pain may occur.
After three to 10 days, the urine darkens, and a yellowish color develops in the skin. Some body fluids, such as bile, build up as a result of getting in the way of the work of the liver. The liver is usually larger than usual and tender, and in 15 to 20% of patients, the spleen is also larger than normal. Then symptoms begin to improve and the person feels better, even as the jaundice gets worse. Jaundice usually reaches its worst in one to two weeks. It then fades over the next two to four weeks.
The signs of chronic hepatitis vary from person to person. About a third of the cases occur after the individual has had acute hepatitis. But most develop without that. In some people, especially those with chronic hepatitis C, there may be virtually no symptoms.
Commonly a person with chronic hepatitis may experience:
- A vague sense of not being well
- A loss of appetite
- Low-grade fever
- Discomfort in the upper part of the stomach area
Sometimes jaundice (a yellowish appearance to the skin because of disturbed liver function) will appear. Eventually, but sometimes not for years or decades, signs of liver disease will appear, including an enlarged spleen, a spider-like pattern of broken capillaries or fluid retention.
Causes and Risk Factors
Hepatitis A virus spreads mainly by contaminated food or water. The contamination may come from poor sanitation or infected blood and body fluids. Because a person may be infectious for two to six weeks before symptoms begin, epidemics can spread. This is especially the case in underdeveloped countries. This infection is most common in children and young adults.
Hepatitis B virus is often transmitted by contaminated blood or blood products. Infection can occur sexually, between a mother and an infant or by sharing needles. A person may carry the infection for six to 25 weeks before symptoms occur. Routine screening of donor blood has dramatically reduced the possibility of a hepatitis B infection after a transfusion. The risk is increased for patients in renal dialysis and oncology units and for hospital personnel in contact with blood.
Hepatitis C virus is most commonly acquired from contaminated blood, either through a transfusion or shared needles. It rarely is transmitted sexually or between a mother and an infant. A person can be infectious without having symptoms for three to 16 weeks. It plays a role in many cases of chronic hepatitis, cirrhosis and liver cancer. A small percentage of people who appear to be healthy carry the hepatitis C virus and have undetectable chronic hepatitis or even cirrhosis. About one in four people with alcoholic liver disease also carry the hepatitis C virus.
Hepatitis E virus is similar to hepatitis A in how it causes epidemics in poorer areas.
Hepatitis B and C viruses are usually responsible for chronic hepatitis. The B virus causes five to 10 percent of the cases and the C virus 75 to 80 percent. Hepatitis A or E viruses do not tend to cause chronic hepatitis. Why infection by some hepatitis viruses causes a chronic condition is not fully understood. Certain types of drugs or possibly genetically determined defects of metabolism may also cause it.
Many cases occur spontaneously and without a cause that can be identified. Wilson's disease, a rare disorder that appears in children and young adults, may appear as chronic hepatitis. There are signs that the immune system may be involved in the process of liver damage, but this is not fully understood yet.