Explore the diverse array of clinical manifestations associated with acute viral hepatitis in this informative presentation. From the prodromal phase to the icteric phase, delve into the spectrum of symptoms including fatigue, jaundice, abdominal pain, and hepatomegaly. Gain insights into the variability of presentation across different viral hepatitis types, and understand the importance of early recognition and management in optimizing patient outcomes

1. CLINICAL MANIFESTATION
OF ACUTE VIRAL HEPATITIS
By Sunidhi Singh
IM 534

2. Definition and Overview
• If the period of inflammation or hepatocellular
injury lasts for less than six months, characterized
by normalization of the liver function tests, it is
called acute hepatitis.
• If the inflammation persists beyond 6 months, it is
termed chronic hepatitis.
• Acute type of hepatitis can either be subclinical,
Self limiting disease (mostly) or fulminant hepatic
failure (1%).

3. • Clinical picture of all viral hepatitis is very much
similar
• It differs by severity of the course of the disease
and its outcomes.
• Viral hepatitis A and E are characterized by cyclic
benign course with complete reconvalescence.
• In hepatitis B, C and D medium serious and serious
course, lingering and chronic forms of disease and
lethal consequences are sometimes observed.

4. Phases:
• Acute viral hepatitis can be divided into four
periods
• Incubation period (different for types of virus)
• Prodromal period (3 days- 1 week)
• Icteric period (2-6 weeks)
• Period of Convalescence (6 weeks to several
months)

5. Prodromal Period:
• flu like symptoms are most common.
• Runny nose, fever, fatigue
• Nausea and vomitting
• Discomfort in RUQ
• Arthralgia
• Gianotti - Crosti Syndrome In hepatitis B

6. Variants of prodromal period:
• Dyspeptic variant: absence of appetite, nausea,
vomitting, subfebrile temperature
• Flu like: fever, sore throat, cough and runny nose,
headache
• Polyarthralgic: Muscle weakness and joint pain
• Asthenovegetative: generalised weakness, malaise,
body ache, subfebrile temperature
• Mixed type: all symptoms of above variants Are
seen.

7. Icteric Period:
• Jaundice: Yellowing of the skin and sclera (whites of
the eyes) due to elevated bilirubin levels.

8. • Dark Urine: Urine appears dark or tea-colored due
to increased bilirubin excretion.
• Pale Stools: Light-colored or clay-colored stools.
• Hepatomegaly: Enlargement of the liver.
• Right Upper Quadrant Pain: Discomfort or pain in
the upper right side of the abdomen.

9. • astheno vegetative symptoms continue, weakness,
sleep disturbances.
• Nausea, bitter mouth, constipation (dyspeptic
syndrome)
• Weight loss, elevation of AST, ALT (cytolitc
syndrome)
• Skin itching, elevated bilirubin (cholestatic
syndrome)
• Hepatosplenomegaly
• Positive thymol turbidity test, Increased gamma
globulins (mesenchymal inflammatory syndrome)
• Muffled heart sounds, bradycardia

10. Convalescent period:
• Resolution of Jaundice: Yellowing of the skin and
eyes gradually improves.
• Recovery: Energy levels improve, and other
symptoms subside.
• Return of Appetite: Normalization of eating
patterns.
• Normalisation of biochemical Indices.

11. Complications:
• Acute hepatic encephalopathy is is a serious
neurologic complication. it involves Buildup of
ammonia and other neurotoxins due to impaired
liver function. Progressing from confusion and
personality changes to stupor and coma, Asterixis.
• Liver failure
• Progression to chronic hepatitis.