Signs and Symptoms of Hepatitis

The symptoms of hepatitis can be confounding, ranging from mild, short-lived flu-like symptoms (e.g., fever and fatigue) to more classic ones, such as jaundice—or even no symptoms at all. Typically, once the symptoms of hepatitis become obvious, chronic liver disease and liver damage are well underway. Serious liver damage can have dire and even life-threatening complications such as cirrhosis and liver cancer.

Symptoms

Symptoms of the three types of hepatitis vary little. In the case of acute viral hepatitis, if symptoms occur, they will begin to appear during the prodromal stage of infection, when the virus has begun to aggressively replicate and spread to the cells of the liver (called hepatocytes).

In order to defend against the virus, the immune system will set off an inflammatory response that can bring on symptoms similar to those of seasonal flu, accompanied by signs more suggestive of a gastrointestinal or liver-related infection, including:

• General tiredness or fatigue
• Muscle pain (myalgia)
• Joint pain (arthralgia)
• Fever
• Nausea
• Vomiting
• Diarrhea
• Loss of appetite
• Pain in the upper right part of the abdomen (generally mild, but constant)
• Red, raised hives (most commonly seen with hepatitis B)
• Changes in the way things taste or smell (smokers will often develop a sudden distaste for cigarettes)

Within several days of these early signs, the infection will trigger the build-up of bilirubin, an orange-yellow pigment produced when the liver breaks down old red blood cells. This compound can rapidly accumulate in the body, causing tell-tale signs of hepatitis:

• Jaundice (yellowing of skin and whites of the eyes)
• Choluria (darkening of urine)
• Pale or clay-colored stools

Symptoms of acute viral hepatitis rarely become severe. However, fatigue can persist for weeks and, in some cases, even months. In most cases, acute symptoms resolve in about four to eight weeks. (One exception is hepatitis D, in which acute liver damage is more common.)

Jaundice typically is the first symptom of non-viral forms of hepatitis, although, as with viral hepatitis, many people experience symptoms during the early stages of liver damage that are less obvious and may easily be mistaken for a garden-variety infection.

Complications

In cases of viral hepatitis, when the virus does not spontaneously clear but instead continues to replicate, the infection is said to be chronic. Depending on the type of hepatitis virus, a chronic infection can persist for years or decades before signs of illness appear.

For both viral and non-viral hepatitis, by the time the disease is evident, the symptoms are, in fact, those of complications of liver damage.

Fibrosis and Cirrhosis

When liver cells are injured, the inflammatory response that results stimulates the production of collagen and other substances. These begin to build up faster than the body can break them down. Over time, the process causes the progressive accumulation of scar tissue, known as fibrosis.

Fibrosis tends to progress more rapidly in men than in women, as well as in people over 50 or those who drink heavily or are obese. In some cases, it can remain stable or even regress over time.

Fibrosis can lead to a complication called cirrhosis—scarring so extensive as to restrict the liver’s blood supply and disrupt normal function. Cirrhosis symptoms can vary, depending on the stage of progression.

There are two classifications of liver cirrhosis, compensated and decompensated.

Compensated cirrhosis, in which the liver has minimal to moderate damage, tends to have few, if any, symptoms. Possible signs include:

• Persistent malaise or fatigue
• Discomfort in the upper right part of the abdomen
• Nausea
• Joint or muscle pain
• An abnormal tingling or burning sensation (paresthesia)
• An uncomfortable "pins-and-needles" sensation (peripheral neuropathy)
• Dry eyes accompanied by dry mouth (sicca syndrome)
• Spider veins, mainly on the trunk and face
• Itchy skin (pruritus)
• Redness on the palms of the hands (palmar erythema)
• Easy bruising or abnormal bleeding (variceal bleeding)
• A build-up of fluid in the ankles and feet (edema)
• Poor concentration and memory
• Loss of appetite
• Weight loss
• Shrinking testicles (testicular atrophy)
• Erectile dysfunction or loss of libido
• Alcohol intolerance

Decompensated cirrhosis is diagnosed if damage is extensive and the liver no longer functions. The symptoms are the result of liver failure and include:

• Jaundice
• Tarry or bloody stools
• Accumulation of fluid in the abdominal cavity, causing swelling and distention (ascites)
• A distinctive "sweet-musty" to "rotten egg" breath odor
• Extreme bruising or bleeding
• Abnormally decreased urine output
• Personality changes, confusion, or tremors
• Increased sleepiness
• Muscle wasting
• White discoloration or "milk spots" on the nails (leukonychia)
• Vomiting of blood

Hepatocellular Carcinoma (HCC)

This is a type of liver cancer that develops almost exclusively in association with cirrhosis in patients with hepatitis B or hepatitis C. The symptoms of HCC are similar to those of decompensated cirrhosis:

• Persistent fatigue
• Jaundice
• Accumulation of fluid in the abdominal cavity (ascites)
• Abnormal bruising and bleeding
• Unintentional, extreme weight loss
• Loss of appetite
• Feeling full after only eating a small amount
• Delirium, confusion, or coarse "jerking" muscle movements

Like decompensated cirrhosis, HCC is considered an end-stage liver disease.

Glomerulonephritis

This kidney disorder most commonly is associated with untreated chronic hepatitis B or hepatitis C infections.

Cryoglobulinemia

Most often linked to chronic hepatitis B or hepatitis C infections, this rare disease is caused by an abnormal cluster of proteins that blocks small blood vessels, leading to circulation problems.

Porphyria Cutanea Tarda

This rare complication of chronic hepatitis C, in which the body has trouble processing chemicals called porphyrins, leads to blistering of the hands and face.

Hepatic Encephalopathy

Hepatic encephalopathy (HE) is inflammation of the brain that can result when the liver becomes unable to remove toxins from the blood, allowing them to travel to the brain. Also called portosystemic encephalopathy, HE affects both physical and mental functioning. Symptoms include:

• Shaking or jerking of the limbs
• Flapping of the arms when held out straight
• Slowed reaction time
• A sweet odor to the breath
• Slowed reaction time
• Slurred speech
• Socially inappropriate behavior
• Personality changes
• Confusion
• Memory loss
• Decreased alertness
• Disorientation in regard to time, location, or date
• Trouble focusing
• Inability to do basic math

Portal Hypertension

Portal hypertension, a complication of alcoholic hepatitis, is a type of high blood pressure that affects the portal veins that lead from the intestines to the liver, blocking the return of blood to the organ from the digestive system. As pressure builds, life-threatening swelling and bleeding of various internal tissues and organs can result.

Co-Infection

Hepatitis can weaken the immune the system, making it less able to fight off other infections. For example, according to the Centers for Disease Control and Prevention (CDC), both hepatitis B and hepatitis C frequently co-exist with human immunodeficiency virus (HIV) infection. And a 2015 study found that people with the hepatitis C virus are at an increased risk of developing tuberculosis, an infectious disease caused by Mycobacterium tuberculosis.

When to See a Healthcare Provider

If you develop any of the symptoms of chronic hepatitis, liver damage, or liver cancer, see your healthcare provider. It takes only a blood test to detect the presence of a hepatitis virus in your body (or antibodies that indicate your immune system has been attempting to fight off such a virus).

A blood test also can determine which hepatitis virus you're infected with, which will determine what your treatment should be (usually an antiviral medication that may not clear the virus from your body, but may prevent it from replicating).

A Word From Verywell

The symptoms of the various forms of viral hepatitis—as well as those of non-viral hepatitis—are similar despite having different causes. What's more, symptoms often aren't apparent until damage to the liver is well underway. By identifying behaviors or traits that put you at greater risk and getting a good medical history, a healthcare provider often can determine that hepatitis may be a cause of a patient's symptoms. From there, testing can be done to confirm the diagnosis.