Hepatitis B

Clinical manifestations

Acute Hepatitis- 

• 70% of Acute HBV infections are subclinical or anicteric.
• 30% of the infections are icteric hepatitis.
• Fulminant hepatitis in Acute HBV infection is usually rare but can occur if there is concomitant exposure to other hepatotoxic agents e.g. Paracetamol.
• Incubation period- 1 to 4 months.
• Signs and symptoms- Fever, malaise, jaundice, upper abdominal pain, nausea, vomiting.
• Lab- Elevated AST and ALT (1000 to 2000 IU/L), elevated Bilirubin levels, PT has Prognostic value.
• In individuals who recover, liver enzymes will normalise in 1 to 4 months.
• Persistent elevation of enzymes beyond 6 months is usually seen in chronic hepatitis.

Chronic hepatitis-

• Most of the patients with chronic hepatitis don’t have a history of Acute HBV infection.
• Most of them are asymptomatic, however, if cirrhosis sets in they may present with decompensated liver disease.
• The physical examination can be normal or there may be stigmata of liver cell failure. Jaundice and splenomegaly may be seen.
• Lab- Liver enzymes can be normal or mildly elevated, if cirrhosis sets in thrombocytopenia and anaemia (hypersplenism), hypoalbuminemia may be seen.
• Extrahepatic manifestations- Polyarteritis nodosa, PAN, Membranous nephropathy, membranoproliferative nephropathy.

Phases of Chronic Hepatitis

• HBeAg +ve Chronic HBV infection.
• HBeAg +ve Chronic Hepatitis.
• HBeAg -ve Chronic HBV infection.
• HBeAg -ve Chronic Hepatitis.
• HBsAg -ve Hepatitis.

Figure 1 Phases of chronic HBV infection

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