hepatic and biliary disorders
Overview of Acute Viral Hepatitis
Symptoms and Signs of Acute Viral Hepatitis
Some manifestations of acute hepatitis are virus-specific (see discussions of individual hepatitis viruses), but in general, acute infection tends to develop in predictable phases: The virus multiplies and spreads without causing symptoms (see table Characteristics of Hepatitis Viruses ). Prodromal (pre-icteric) phase:Nonspecific symptoms occur; they include profound anorexia, malaise, nausea and vomiting, a newly developed distaste for cigarettes (in smokers), and often fever or right upper quadrant abdominal pain. Urticaria and arthralgias occasionally occur, especially in HBV infection. After 3 to 10 days, the urine darkens, followed by Jaundice . Systemic symptoms often regress, and patients feel better despite worsening jaundice. The liver is usually enlarged and tender, but the edge of the liver remains soft and smooth. Mild splenomegaly occurs in 15 to 20% of patients. Jaundice usually peaks within 1 to 2 weeks. Recovery phase:During this 2- to 4-week period, jaundice fades. Appetite usually returns after the first week of symptoms. Acute viral hepatitis usually resolves spontaneously 4 to 8 weeks after symptom onset. Anicteric hepatitis(hepatitis without jaundice) occurs more often than icteric hepatitis in patients with HCV infection and in children with HAV infection. It typically manifests as a minor flu-like illness. Recrudescent hepatitisoccurs in a few patients and is characterized by recurrent manifestations during the recovery phase. Manifestations of cholestasismay develop during the icteric phase (called cholestatic hepatitis) but usually resolve. When they persist, they cause prolonged jaundice, elevated alkaline phosphatase, and pruritus, despite general regression of inflammation. 