As with all viral infections, the severity of symptoms can vary widely, from
none to very severe symptoms. Most people with hepatitis B will have some
periods in their lives when they are free of symptoms, while others may not develop
symptoms for decades or even their whole lifetime. Unfortunately, other people
can experience severe hepatitis B symptoms.
The 2 forms of illness related to hepatitis B infection are acute hepatitis
B and chronic hepatitis B.
Acute hepatitis B
In the acute, short-term, form of hepatitis B, very severe inflammation
of the liver occurs. People with acute hepatitis become very fatigued, and
may develop jaundice, in which the whites of the eyes or the roof of the mouth
become noticeably yellow. As hepatitis can be caused by many things besides
hepatitis B virus, the doctor needs to do special viral tests to determine the
cause. Acute hepatitis B can also cause fever, loss of appetite, loss of taste
for cigarettes, and pain in the lower right chest or upper right abdomen. There
is often a feeling of bloating in the abdomen, and bowel habits may change.
The urine may appear dark or cola-colored, and the bowel movement may appear
Blood tests show many abnormalities. Liver enzymes called ALT or AST rise
substantially. The bilirubin level may rise and in severe cases, the
liver's function may be impaired, causing problems with blood clotting and control
of body fluids. Rarely, acute hepatitis B causes enough liver damage to require
transplantation or even result in death.
In the majority of cases, however, acute hepatitis B will disappear on its own
after several weeks to a few months. Rest is the main treatment.
Chronic hepatitis B
In about 10% of acute cases, hepatitis B will not disappear completely
but will progress to a chronic infection. Chronic infections can have several
different outcomes depending on how a person's immune system responds. Unfortunately,
when infection occurs during infancy, the immune response is poor, and up to
90% of infected infants or 50% of infected children under the age of 5 grow
up carrying active hepatitis B virus for life. Often this chronic infection
will lead to problems when the person reaches their 30s or 40s. However, some
people eventually fully recover, while others will tolerate the infection well
for life. Other individuals with lifelong infection eventually develop chronic
liver disease, even after decades of living free of symptoms.
In some people who have had chronic hepatitis for years, scarring, or cirrhosis,
may develop in the liver. The symptoms of cirrhosis include fatigue, ankle or
abdomen swelling, hemorrhoids, bruising, or bleeding. In severe cirrhosis, the
veins lining the gastrointestinal system may enlarge and cause bleeding.
When liver function is severely limited, the organ is no longer able to clear
the toxic wastes from digesting foods, and the brain becomes affected. This
may cause changes in sleep patterns, thinking patterns, or mood patterns.
Men with chronic hepatitis B infection are also more prone to develop liver
cancer, called hepatocellular carcinoma. Cirrhosis increases the likelihood
of liver cancer occurring. The cancer is common in areas where the infection
It is important to remember that chronic hepatitis B will not necessarily
cause significant disease in many people. But only after examination and special
testing will your doctor be able to know the status of your liver and your hepatitis
B infection. Hepatitis infection often changes with time. Because the infection
is chronic, your doctor will need to monitor you every so often with examinations