Acute Hepatitis
Fulminant Hepatitis
Post-Hepatitis Syndrome
Prolonged Choleostasis
Hepatocellular Carcinoma

Acute Hepatitis
The clinical course of HBV runs similarly to that of Hepatitis A Virus (HAV), but tends to be more severe and may be associated with serum-sickness-like syndrome.
The mildest attacks are asymptomatic and are detectable only by an increase in serum transaminase levels. Alternatively, patients may be anicteric, but may suffer from gastrointestinal and influenza-like symptoms. These patients are likely to remain undiagnosed unless a clear history of exposure is available. The severity of infection may vary from the asymptomatic and icteric (from which recovery is typical) through to fulminant, fatal viral hepatitis.
Icteric attacks in adults are marked by a prodromal period (typically three to four days, but may last up to two or three weeks) during which patients feel sickly, suffer from digestive symtoms such as anorexia and nausea and may, in the later stages, have mild pyrexia. Other common symptoms are rigors, loss of desire to drink alcohol or smoke, malaise, and occasionally, severe headaches. The prodromal period is followed by the darkening of urine and lightening of feces, followed by the development of jaundice.

Cirrhosis can be characterized anatomically by widespread nodules in the liver combined with fibrosis. These excessive nodules and fibroids result in the distortion of the normal liver architecture and interfere with blood flow through the liver. Cirrhosis may also result in the inability of the liver to perform its functions as abnormalities progressively develop.

Fulminant Hepatitis
This is a rare form of the disease which usually overwhelms the patient within ten days. This form may develop so quickly that jaundice is inconspicuous and may be confused with acute psychosis or meningo-encephalitis. On the other hand, the patient may become deeply jaundiced. Forboding signs may be repeated vomiting, fetor hepaticus, confusion, and drowsiness. The 'flapping' tremor may only be transient, but rigidity is usual. These are then supervened by coma, indicating likely acute liver failure. The patient's temperature rises, jaundice deepens, and liver shrinks, possibly accompanied by widespread hemorrhages.
The levels of serum bilirubin and transaminase are poor prognostic indicators because transaminase levels may actually decrease as the patient's clinical condition worsens. Prothrombin is the best indicator of prognosis. Frequency of the fulminant course varies, depending upon the type of viral hepatitis and prevalence of hepatitis B carriage.

Post-Hepatitis Syndrome
Adult patients feel less-than-perfect for variable spans of time following acute hepatitis. Typically, this period lasts for a few weeks, but may extend into months. Common features are anxiety, fatigue, failure to regain weight, anorexia, alcohol intolerance, and right upper abdominal discomfort. The edges of the liver may be tender. Serum transaminase levels may be up to three times that of normal.
Hepatic histology reveals mild, residual portal zone cellularity and fibrosis, and sometimes fatty changes in the liver cells. These conditions do not differ from patients found to be recovering normally and who are now symptom-free. Thus, a liver biopsy should not be done within six months after acute hepatitis as there may be difficulty in distinguishing the residual changes from developing chronic hepatitis.

Prolonged Cholestasis
Occasionally, prolonged jaundice is of the cholestatic type. The onset is acute, and as the jaundice deepens within the first three weeks, the patient begins to itch. After the first few weeks, the patient feels well, gains weight, and is asymptomatic apart from icterus and slight hepatomegaly. Jaundice persists for 8 - 29 weeks, after which recovery is complete.

In 1.8% - 15% of cases, some of the original attack is duplicated, but typically in a milder form. Often, relapse is simply shown by an increase in serum transaminases and bilirubin. Relapses may be a result of premature activity or intake of large amounts of alcohol. Multiple relapses may occur. However, full recovery may follow, though in some patients, relapses may indicate progression to chronic hepatitis.

Hepatocellular Carcinoma (HCC)
Hepatocellular carcinoma is the technical term for liver cancer. This form of the disease develops after a long time in individuals suffering from chronic hepatitis B infection. What events trigger the development of this disease are currently unknown.


Gimson, A.E.S., White, Y.S., Eddleston, A.L.W.F. et al. 1983. Clinical and Prognostic Differences in Fulminant Hepatitis Type A, B, and non-A, non-B. Gut.; 24: 1194.

Gordon, S.G., Reddy, K.R., Schiff, L. et al. 1984. Prolonged Intrahepatic Cholestasis Secondary to Acute Hepatitis A. Ann. Intern. Med.; 101: 635.

Sherlock, S. and Walshe, V.M. 1946. The Post-Hepatitis Syndrome. Lancet; ii: 482.

Tabor, E. 1987. Guillain-Barre Syndrome and Other Neurological Syndromes in Hepatitis A, B, non-A, non-B. J. Med. Virol.; 21: 207.

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