Viral Hepatitis Signs, Symptoms, & Treatment

Viral hepatitis is a serious disease that affects millions of people worldwide. It causes inflammation of the liver and can cause severe damage to the organ. 

Most people who get infected with viral hepatitis do not even realize they have it until it has progressed to a point where it becomes very difficult to treat. In fact, most people who contract viral hepatitis will never know they had it unless they develop symptoms.

If you suspect you may have contracted viral hepatitis, then you should contact your doctor immediately. He or she can help determine whether you have acute or chronic hepatitis and provide treatment accordingly.

In this article I’ll describe the signs and symptoms of viral hepatitis, as well as how to diagnose and treat it.

Harsh Facts: Hepatitis and Liver Cleansing

Hepatitis has been making the rounds since Dr. Hippocrates pronounced it an infectious disease in the 5th century.

Today, there are at least five known strains of this common liver disease. Hepatitis B alone affects over 300 million people around the world.

Viral Hepatitis

What is Viral Hepatitis?

In general terms, hepatitis means inflammation of the liver. Hepatitis is not one, but many diseases in which the liver becomes inflamed, and its cells are damaged as a result of inflammatory chemicals being produced and released in the liver.

Though hepatitis commonly results from one of five recognized hepatitis viruses – A, B, C, D, or E – it can also be caused by excessive alcohol, toxins, an unhealthy diet, various drugs, autoimmune diseases, metabolic disorders, poisons, fungal infections, and certain other viral infections (i.e. yellow fever, herpes, mumps, rubella), as well as some diseases of the biliary system.

Some forms of hepatitis are sudden and short-term (acute) while others are long-lasting (chronic) and sometimes lifelong. While some types can become life-threatening, others have few or no long-lasting effects.

  • Approximately 25% of people who consume three or more alcoholic drinks per day during a period of 10-15 years will experience some level of alcoholic hepatitis.
  • One of the most common infectious diseases in the world, the yearly death toll from hepatitis B infections is estimated at between 500,000 and 1.2 million worldwide. Hepatitis B is more likely to become a chronic infection in children who are exposed.  Adults are more likely to recover.
  • Though hepatitis C, a lethal virus for which no vaccine exists, can remain asymptomatic for years, it may eventually lead to a chronic form of hepatitis, culminating in cirrhosis. Hepatitis C treatments have drastically improved in the last several years, curing it in over 95% of cases.
  • Hepatitis D and E are less common, and can occur in conjunction with other forms of hepatitis as well as on their own.

Hepatitis A To E

1. Hepatitis A

It is usually spread through water or food that has been contaminated by the feces of someone with the virus.

Those most at risk are people who live in areas where outbreaks of hepatitis A are common; international travelers; people living with, or those having sex with, infected person(s); and, during outbreaks, intravenous drug users, men who have in sex with men, and day care children and employees.

A vaccine is available, and travelers are advised to avoid tap water and practice exemplary hygiene and sanitation while traveling. Hepatitis A often resolves itself after several weeks, with no specific treatment other than supportive care.

2. Hepatitis B:

It is transmitted through contact with infected blood, sexual intercourse with infected person(s), or from mother to child during childbirth.

At risk are people living with, or those having sex with, infected person(s); men who have sex with men; intravenous drug users; children of immigrants from areas where the disease persists; infants born to infected mothers; health care workers; hemodialysis patients; international travelers; and, though these cases are now quite rare, people who received a transfusion of blood or blood products prior to July 1992, or clotting factors made before 1987.

Tattooing and touching the wounds of an infected person are also cited as risk factors.

A hepatitis B vaccine is available. While acute hepatitis B often resolves on its own in adults, chronic hepatitis B patients can be treated with tenofovir, entecavir, lamivudine, or adefovir dipivoxil.

3. Hepatitis C:

It is spread primarily through contact with infected blood, and less commonly through sexual contacts and childbirth.

Most at risk are intravenous drug users; people who have sex with infected person(s); people who have multiple sexual partners; health care workers; infants born to infected women; hemodialysis patients; and people who received a transfusion of blood or blood products prior to July 1992, or clotting factors made before 1987.

There is no vaccine for hepatitis C, and the only way to prevent the disease is to reduce the risk of transmission. Avoiding behaviors such as sharing drug needles or personal items like toothbrushes, razors, and nail clippers with infected person(s) is recommended.

Chronic hepatitis C can be treated with one of several different treatment options that have developed over the last several years – usually requiring medication for 2-3 months.

4. Hepatitis D:

It is transmitted through contact with infected blood. This disease occurs only in people who are already infected with hepatitis B. Others at risk are intravenous drug users; people who have hepatitis B and those who have sex with person(s) infected with hepatitis D; or people living with infected person(s).

People who received a transfusion of blood or blood products before July 1992, or clotting factors made before 1987.

Prevention involves immunization against hepatitis B for those not already infected, and avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items.

5. Hepatitis E:

It is spread through water or food that has been contaminated by feces from someone with the virus. Though uncommon in the U.S., international travelers, people living in areas where hepatitis E outbreaks are common, and people who live or have sex with infected person(s) are at risk.

There is no vaccine for hepatitis E, and the only way to prevent the disease is to reduce the risk of exposure to the virus. This means avoiding tap water when traveling internationally, and practicing good hygiene and sanitation.

Hepatitis E usually resolves itself after several weeks or months. Disease course can be more severe in pregnant women.

What is Cirrhosis?

Cirrhosis is a liver disorder caused by a loss of liver cells and severe scarring of liver tissue. A result of chronic liver disease, cirrhosis is characterized by the replacement of liver tissue with fibrotic scar tissue and regenerative nodules.

Cirrhosis damages the liver so extensively that the organ may no longer be able to function, sometimes resulting in death. The condition is irreversible in its advanced stages, with the only option being a liver transplant.

Cirrhosis leads to liver cancer in approximately 10% of all cases. In 2000, it was the leading cause of death in the U.S. Learn about Liver Cancer Early Symptoms.

Symptoms of cirrhosis may include, but are not limited to:

  • An increase in male breast tissue
  • Anorexia
  • Ascites, excess fluid in the abdomen
  • Change in liver size
  • Changes in the nails and palms
  • Dark urine
  • Fatigue
  • Impotence, infertility, or loss of sexual drive due to reduced hormone secretion from the testes or ovaries
  • Jaundice, a yellowing of the skin, eye, and mucus membranes
  • Strong, sweet-smelling breath
  • Weight loss
  • Weakness

While in the western world, cirrhosis is most commonly caused by alcoholism and hepatitis C, there are various other causes such as autoimmune hepatitis or chronic hepatitis B, non-alcoholic steatohepatitis (NASH), primary biliary cirrhosis or primary sclerosing cholangitis, hereditary hemochromatosis, Wilson’s disease, alpha 1-antitrypsin deficiency, and cardiac cirrhosis.

From Virus to Disease

Though the exact mechanism by which hepatitis viruses develop into the disease is unknown, the onset of hepatitis is thought to be the immune system wreaking havoc, rather than a result of the virus itself.

A complex network of chemicals, cells, tissues, and organs, the immune system is designed to protect us against attack from foreign invaders such as bacteria and viruses.

When an attack is perceived, the immune system responds by producing antibodies designed to destroy the invader. The liver, it appears, becomes inflamed as a result of the presence of these antibodies, rather than because of the hepatitis virus.

Other Causes of Hepatitis

Many drugs can cause hepatitis. Some include the antifungal ketoconazole, certain oral contraceptives, ibuprofen, an antibiotic called nitrofurantoin, an antidepressant known as amitriptyline, the anti-hypertensive treatments methyldopa and nifedipine, the antiarrhythmic amiodarone, and the aesthetic gas halothane.

A variety of common environmental toxins can cause hepatitis. These include:

  • Amatoxin-containing mushrooms
  • Carbon tetrachloride, a dry cleaning agent; also used in fire extinguishers
  • Chloroform, used in refrigerants, propellants, resins, and as a solvent
  • Paracetamol, aka acetaminophen
  • Trichloroethylene, an industrial solvent used to remove grease from fabricated metal parts, some textiles, as a refrigerant, and fumigant
  • Yellow phosphorous, an industrial toxin

Hepatitis – Signs and Symptoms

The symptoms of various hepatitis forms are similar, the most noticeable being jaundice. As the viral infection spreads throughout the liver, the organ becomes enlarged, often causing abdominal pain.

  • Abdominal pain
  • Dark urine
  • Enlarged liver
  • Fatigue
  • General achiness
  • Headache
  • Jaundice
  • Joint aches
  • Loss of appetite
  • Malaise
  • Mild fever
  • Vomiting two to three times per day, during the first five days

Unfortunately, with some chronic forms of hepatitis there are very few signs, and symptoms occur only when a longstanding inflammation has developed into cirrhosis.

Although as many as 50% of hepatitis B carriers, and 75% of children with hepatitis A never show symptoms, they are nonetheless carriers of the disease, and can pass the virus on to others.

The appearance of jaundice is often the first step in diagnosing hepatitis. Diagnostic blood tests are available for all forms of viral hepatitis.

Prognosis for Hepatitis

There are various treatments, but no known cure for hepatitis. As much bed rest as possible is highly recommended, as well as a healthy diet and lots of fluids. Avoiding alcoholic drinks is critical.

Prognosis varies a great deal, and is dependent upon the cause. Many hepatitis A and B patients make a complete recovery within a few months. Hepatitis A sufferers become immune to the hepatitis A virus, and will not become reinfected with the disease.

About 10% of hepatitis B patients develop serious complications such as cirrhosis of the liver and liver cancer, as do approximately 15% of patients with hepatitis C, who are prone to chronic hepatitis or other liver-related disorders.

Prevention, Treatment, and Caring for your Liver

There are vaccines for hepatitis A and B, and these are recommended for those at risk such as health care workers or those traveling to areas where hepatitis is common.

Vaccines are also available for people who’ve already been exposed to hepatitis A or B and, if given soon after exposure, can be quite effective.

Hepatitis infection can be avoided by the implementation of certain lifestyle regimens:

  • Boil water thoroughly, and wash fruits and vegetables before eating when traveling in undeveloped areas
  • Do not share needles with other intravenous drug users
  • Do not share personal items of the skin damaging variety, such as toothbrushes, razors, scissors, and nail files
  • Use condoms during oral, vaginal, and anal sex
  • Wash hands frequently, especially after toilet use or contact with another’s blood
  • When living and working in unsanitary or heavily populated conditions, it is especially important to implement these precautions

Detoxify Your Liver – A Step on the Road to Recovery

Environmental pollution comes in many forms.

  • The air we breathe is choking with car exhaust and burned fossil fuels.
  • Waterways are ripe with pesticides, domestic sewage, bacteria, fungi, and viruses.
  • The soil in which we grow our food is poisoned with fertilizers, herbicides, and insecticides. 
  • Some communities are now dealing with radiation leakages from nuclear plants.

The products we use to make our lives easier are taking a toxic toll on us, too. We are surrounded by steel and pulp mill waste, and sulphur dust from cement factories.

The sprays, lotions, and perfumes we douse ourselves with each day are full of harmful chemicals. We are bombarded with noise from traffic and city living.

Even music – ubiquitous in every social setting – is considered a pollutant, taxing the body alongside the chemicals we’re exposed to.

Toxins are a heavy burden on our bodies’ immune systems. The liver is such a vital organ, because it’s the one responsible for regulating certain chemicals in the blood and removing substances that are, or may become, toxic.

Ridding ourselves of the pollutants we ingest, inhale, and absorb through our skin on a daily basis has become an enormous job. If possible, go with organic foods to avoid pesticide residue in food.

Learn more about other liver conditions:

Julie C. Guider MyGoodGut

Medically reviewed by Julie Guider, M.D.

Dr. Julie Guider earned her medical degree from Louisiana State University School of Medicine. She completed residency in internal medicine at the University of Virginia. She completed her general gastroenterology and advanced endoscopy fellowships at University of Texas-Houston. She is a member of several national GI societies including the AGA, ACG, and ASGE as well as state and local medical societies.