Although most people find that hepatitis is a single disease, this term actually refers to any situation where liver inflammation occurs. Many diseases and complications can cause hepatitis, for example, use of drugs, medications, excess or chronic use of alcohol, chemicals, autoimmune diseases, infections of various types of virus or accumulation of fat in the liver (hepatic steatosis).
In this article we will cover the main signs and symptoms of hepatitis. We will emphasize acute hepatitis, since patients with chronic hepatitis usually spend asymptomatic years, developing symptoms only when there are already signs of cirrhosis.
Although there are several causes for acute hepatitis, its symptoms turn out to be very similar, since, in the end, it all boils down to a liver inflamed and unable to work properly.
Jaundice is probably the most characteristic symptom of hepatitis. We call jaundice the yellowish coloration of the skin, eyes and mucous membranes caused by the accumulation in the blood of a substance called bilirubin.
Let's spend a few lines explaining what bilirubin is, since various symptoms of hepatitis are caused by its buildup in the body.
Our red blood cells live on average 120 days, being destroyed in the spleen when they are already old. One of the elements released by the red cell when it is destroyed is bilirubin, a yellow-green pigment.
Millions of old red blood cells are destroyed every day in the spleen, causing a constant release of bilirubin into the blood. So that this bilirubin does not accumulate in the body, it has to eliminate it in some way. This is where our liver comes into action.
One role of the liver is to collect this circulating bilirubin in the blood, metabolize it and excrete it into the intestines so that it is eliminated in the stool.
In hepatitis, the liver is inflamed and diseased, losing the ability to metabolize and/or eliminate the bilirubin that is constantly produced by the spleen. Therefore, it is very common in hepatitis cases to have accumulation of bilirubin in the blood. This excess of bilirubin ends up extravasating to the skin and mucous membranes, causing the yellowish appearance of the same ones.
Jaundice is a typical sign of hepatitis, but it can also occur in other liver diseases, such as cirrhosis or Gilbert syndrome, infections, as yellow fever or leptospirosis, or when there is massive destruction of red blood cells, a framework called hemolysis.
The presence of clear, almost white feces is called fecal suppura, and is also a common sign of hepatitis.
The origin of the fecal suppura is the same as that of jaundice. Bilirubin is the substance responsible for brown stools. If the liver is inflamed and malfunctioning, the bilirubin that reaches it can not be metabolized or excreted into the stool, preventing the faecal cake from having its characteristic coloration.
Dark urine is another sign of hepatitis that occurs due to the accumulation of bilirubin in the blood.
The role of the kidneys in our body is to filter the blood, eliminating unnecessary or excess substances. And that is exactly what the kidneys do in patients with jaundice; they excrete the excess of bilirubin, which because it is a dark pigment, ends up darkening the urine, leaving it with Coca-Cola or matte color.
Jaundice is often associated with itching, as bilirubin deposited on the skin causes irritation of the nerve endings.
Often the hepatitis patient has mild jaundice, which can go unnoticed, especially if the individual has darker skin. Therefore, in some cases, the accumulation of bilirubin in the skin manifests more as a diffuse and seemingly unexplained itch than properly as a yellowish skin.
The inflammation of acute hepatitis can cause a swelling of the liver, causing pain in abdomen. Hepatitis pain is characteristically located in the upper right quadrant of the abdomen, just below the ribs, exactly where the liver is located. In some cases, the liver may be swollen and may be palpated by examination of the abdomen.
Hepatitis always causes a poorly specific picture of malaise, which can include various symptoms such as weakness, easy tiredness, loss of appetite, muscle pain, joint pain, diarrhea, rash (red patches on the body), nausea and vomiting. If the patient does not develop jaundice, the diagnosis of hepatitis may not be considered from the outset, as the condition ends up resembling a nonspecific virus or food poisoning.
Another common manifestation of hepatitis, but very little specific, is fever. Hepatitis fever is typically low and is usually accompanied by some of the non-specific symptoms described in the previous section.
Rarely, the picture of hepatitis may manifest as acute liver failure, called fulminant hepatitis. The inflammation is so intense that the liver, a vital organ, stops functioning altogether, leading to a catastrophic picture.
Patients with fulminant hepatitis may exhibit a variety of complications, such as reduced level of consciousness, coma, cerebral edema, acute renal failure, severe hypoglycemia, spontaneous hemorrhages, and multiple organ failure. The only effective treatment for these cases is urgent liver transplantation.
