Which of the following is not usually present during the icteric stage of viral hepatitis?

Hepatitis is defined as inflammation of the liver. Viral hepatitis is one of the various forms of hepatitis and refers to infections caused by viruses that affect the liver. Viral hepatitis includes five distinct diseases, caused by five different viruses. The different viruses are each called by a letter name:

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D
• Hepatitis E

Hepatitis B Types

There are two types of hepatitis B infections:

• Acute infection. When a person is first infected with hepatitis B, it is called an acute infection. Symptoms range from no symptoms to liver failure. Usually, adults recover from this and have no further problems.
• Chronic infection. If the virus remains in the blood for more than six months, then it is considered a chronic infection. While most adults do not develop chronic hepatitis B, infants and young children are less able to rid their bodies of the virus and may develop chronic hepatitis B as a result.

Those with chronic hepatitis B infection are at an increased risk for development of liver cancer. If you have chronic hepatitis B infection, your doctor will monitor you closely with surveillance imaging (usually every six months).

Hepatitis B Symptoms

Hepatitis B may develop without any signs or symptoms, or symptoms may be nonspecific and short-lived.

Acute Hepatitis B Symptoms

There are three phases of acute hepatitis B infection, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:

• Fever
• Joint pain or arthritis
• Rash
• Edema (swelling)

Symptoms of the next phase, the preicteric phase, include:

• Fatigue
• Myalgia (muscle pain)
• Anorexia
• Nausea and/or vomiting
• Fever
• Cough
• Abdominal pain and/or diarrhea
• Dark urine and light stool color

During the icteric phase:

• Jaundice (yellowing of the skin and whites of the eyes) develops
• Anorexia, nausea and vomiting may worsen
• Irritated skin lesions may develop
• Other symptoms may subside

Chronic Hepatitis B Symptoms

Most patients with chronic hepatitis B are asymptomatic unless their disease progresses. Others might have nonspecific symptoms, such as fatigue.

Some patients experience worsening of the infection and develop signs and symptoms similar to acute hepatitis.

If patients with chronic hepatitis B progress to cirrhosis (when the liver becomes severely scarred) they will develop signs and symptoms of liver failure, including:

• Jaundice
• Splenomegaly (an enlarged spleen)
• Ascites (fluid retention in the abdomen)
• Peripheral edema (swelling of extremities, especially in the legs and feet)
• Encephalopathy (When the liver isn't functioning well, it can't clear toxins from the body. These toxins build up in the blood and affect brain function, leading to confusion.)
• Hepatocellular carcinoma (liver cancer)

Hepatitis B Diagnosis

Hepatitis B diagnosis begins by conducting a thorough physical examination, during which you describe your symptoms and medical history. Other procedures used to diagnose hepatitis B:

• Diagnostic Tests
• Liver Biopsy

Diagnostic Tests

A blood test will be ordered to look for abnormal levels of certain enzymes in your blood. Your doctor may order a liver panel, which is a series of blood tests used to gauge liver function. It is also common for a patient with hepatitis B to have a low white blood cell count, so your doctor may also request a complete blood count.

If the blood tests show the presence of hepatitis B surface antigen (HBsAg) for longer than six months, that is a sign of chronic hepatitis B.

There are also non-invasive imaging tests that your doctor may order to estimate the amount of scar tissue in the liver (called fibrosis), which results from liver inflammation over time. These tests are ultrasound or magnetic resonance imaging (MRI) elastography.

Liver Biopsy

During a liver biopsy, liver tissue is removed and sent to a pathology lab for analysis to determine if you have hepatitis B and how much scar tissue is present.

It may be necessary if:

• Other tests were inconclusive
• Your symptoms were atypical
• Your doctor found evidence of chronic liver disease

Treatment Hepatitis B Treatment

Acute hepatitis B usually resolves on its own without intervention. Treatment for chronic hepatitis B includes medications to suppress the virus and reduce the risk of long-term medical complications.