Hepatitis B Symptoms

Half of all people infected with the hepatitis B virus have no symptoms and may never realize that they have been infected. Adults are more likely to develop symptoms than children. For those who do get sick, symptoms usually develop within 1 to 4 months after exposure to the virus. The initial symptoms are often similar to the flu.

Common symptoms of hepatitis B include:

• Appetite loss
• Feeling tired (fatigue)
• Nausea and vomiting
• Itching all over the body
• Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage)
• Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color)
• Dark urine (the color of cola or tea)
• Pale-colored stools (grayish or clay colored)

Many types of acute viral hepatitis such as hepatitis A and hepatitis C have symptoms that are indistinguishable from hepatitis B.

What is Acute Fulminant Hepatitis?

Fulminant hepatitis is a severe form of acute hepatitis that can be life-threatening if not treated immediately. Fortunately, fulminant hepatitis is rare. The symptoms of fulminate hepatitis develop very suddenly and may include:

• Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy)
• Sudden collapse with fatigue
• Jaundice
• Swelling of the abdomen

Prolonged nausea and vomiting can cause dehydration. Individuals with dehydration may notice these symptoms:

• Extreme weakness
• Confusion or trouble concentrating
• Headache
• Lack of urination
• Irritability

Symptoms of liver damage may include the following:

• Fluid retention causing swelling of the belly (ascites) and sometimes the legs
• Weight gain due to ascites
• Persistent jaundice
• Loss of appetite, weight loss, muscle wasting
• Vomiting with blood in the vomit (Hematemesis)
• Bleeding from the nose, mouth, or rectum; or blood in the stool
• Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

What determines the outcome of acute Hepatitis B?

The body’s immune response is the major determinant of the outcome in acute hepatitis B. Individuals who develop a strong immune response to the infection are more likely to clear the virus and recover. However, these patients also are more likely to develop more severe liver injury and symptoms due to the strong immune response that is trying to eliminate the virus. On the other hand, a weaker immune response results in less liver injury and fewer symptoms but a higher risk of developing chronic hepatitis B. People who recover and eliminate the virus will develop life-long immunity, that is, protection from subsequent infection from hepatitis B.

Most infants and children who acquire acute hepatitis B viral infection have no symptoms. In these individuals, the immune system fails to mount a vigorous response to the virus. Consequently, the risk of an infected infant developing chronic hepatitis B is greater than 95%. In contrast, only 5% of adults who have acute hepatitis B develop chronic hepatitis B.

When to Seek Medical Care

Call your health care professional if you have any of the following:

• Nausea and vomiting that does not go away in 1-2 days
• The inability to keep down liquids
• A high fever or fever that persists more than 2 days
• Yellow skin or eyes
• Dark-colored urine (like tea or cola)
• Pain in the abdomen.

For severe symptoms including confusion or delirium go to a hospital emergency department.

You should also contact your health care practitioner if you think you may have been exposed to the hepatitis B virus.

If you have chronic hepatitis B infection and think you might be pregnant; or if you are pregnant and think you have been exposed to hepatitis B, inform your health care practitioner right away.

What are the symptoms of Chronic Hepatitis B?

The liver is a vital organ that has many functions. These include a role in the immune system, production of clotting factors, producing bile for digestion, and breaking down toxic substances, etc. Patients with chronic hepatitis B develop symptoms due to failure of liver to perform these functions. The signs and symptoms of chronic hepatitis B vary widely depending on the severity of the liver damage. They range from few and relatively mild signs and symptoms to signs and symptoms of severe liver disease such as cirrhosis or liver failure.

Most individuals with chronic hepatitis B remain symptom free for many years or decades. During this time, the patient’s blood tests usually are normal or only mildly abnormal. Some patients may deteriorate and develop inflammation or symptoms, putting them at risk for developing cirrhosis earlier.

Cirrhosis of the liver due to Hepatitis B

Inflammation from chronic hepatitis B can progress to cirrhosis (severe scarring) of the liver. Significant amounts of scarring and cirrhosis lead to liver dysfunction.

Symptoms may include:

• weakness,
• fatigue,
• loss of appetite,
• weight loss,
• Breast enlargement in men, (gynaecomastia)
• Rash on the palms, (palmer erythema)
• Difficulty with blood clotting, bleeding tendency from various sites.
• Spider like blood vessels on the skin. (spider nevi)

Decreased absorption of vitamins A and D can cause impaired vision at night and thinning of bones (osteoporosis). Patients with liver cirrhosis also are at risk of infections because the liver plays an important role in the immune system.

Advanced cirrhosis of the liver due to Hepatitis B:

In patients with advanced cirrhosis, the liver begins to fail. This is life-threatening condition.

Several complications occur in advanced cirrhosis:

• Confusion and even coma (encephalopathy) results from the inability of the liver to detoxify certain toxic substances like nitrogenous waste products.
• Increased pressure in the blood vessels of the liver (portal hypertension) causes fluid to build up in the abdominal cavity (ascites) and may result in engorged veins in the oesophagus (esophageal varices) that tear easily and may cause massive bleeding in vomiting.
• Portal hypertension can also cause kidney failure or an enlarged spleen resulting in a decrease of blood cells and the development of anemia, increased risk of infection and bleeding.
• In advanced cirrhosis, liver failure also results in decreased production of clotting factors. This causes abnormalities in blood clotting and sometimes spontaneous bleeding.
• Patients with advanced cirrhosis often develop jaundice because the damaged liver is unable to eliminate a yellow compound, called bilirubin.

Hepatitis B virus and primary liver cancer (hepatocellular carcinoma)

Patients with chronic hepatitis B are at risk of developing liver cancer. The way in which the cancer develops is not fully understood. Symptoms of liver cancer are nonspecific. Some patients have no symptoms, or they may experience abdominal pain and swelling, an enlarged liver, weight loss, and fever. The most useful diagnostic screening tests for liver cancer are a blood test for a protein produced by the cancer called alpha-fetoprotein and an ultrasound imaging study of the liver. These two tests are used to screen patients with chronic hepatitis B, especially if they have cirrhosis or a family history of liver cancer.

Hepatitis B virus involvement of organs outside of the liver (extra-hepatic)

Rarely, chronic hepatitis B infection can lead to disorders that affect organs other than the liver. These conditions are caused when the normal immune response to hepatitis B mistakenly attacks uninfected organs.

Among these conditions are:

• Polyarteritis nodosa: It is a disease characterized by inflammation of the small blood vessels throughout the body. This condition can cause a wide range of symptoms, including muscle weakness, nerve damage, deep skin ulcers, kidney problems, high blood pressure, unexplained fevers, and abdominal pain.
• Glomerulonephritis: another rare condition, which is inflammation of the small filtering units of the kidney.