Hepatitis B (cont.)
What are the symptoms of chronic hepatitis B?
The liver is a vital organ that has many functions. These include a role in
the immune system, production of clotting factors, producing bile for digestion,
and breaking down toxic substances, etc. Patients with chronic hepatitis B
develop symptoms in proportion to the degree of abnormalities in these
functions. The signs and symptoms of chronic hepatitis B vary widely depending
on the severity of the liver damage. They range from few and relatively mild
signs and symptoms to signs and symptoms of severe liver disease such as
cirrhosis or liver failure.
Most individuals with chronic hepatitis B remain symptom
free for many years or decades. During this time, the patient's blood tests
usually are normal or only mildly abnormal. Some patients may deteriorate and develop inflammation or
symptoms, putting them at risk for developing cirrhosis.
Cirrhosis of the liver due to hepatitis B
Inflammation from chronic hepatitis B can progress to
cirrhosis (severe scarring) of the liver. Significant amounts of scarring and
cirrhosis lead to liver dysfunction.
Symptoms may include:
- weakness,
- fatigue,
- loss of appetite,
- weight loss,
- breast enlargement in men,
- a rash on the palms,
- difficulty with blood clotting, and
- spider-like blood vessels on the skin.
Decreased absorption of vitamins A and D can cause impaired vision at night and
thinning of bones (osteoporosis). Patients with liver cirrhosis also are at risk of infections
because the liver plays an important role in the immune system.
Advanced cirrhosis of the liver due to hepatitis B
In patients with advanced cirrhosis, the liver begins to fail. This is
life-threatening condition.
Several complications occur in advanced cirrhosis:
- Confusion and even coma (encephalopathy) results from the inability of the
liver to detoxify certain toxic substances.
- Increased pressure in the blood vessels of the liver
(portal hypertension) causes fluid to build up in the abdominal cavity (ascites) and may result in
engorged veins in the swallowing tube
(esophageal varices) that tear easily and
may cause massive bleeding.
- Portal hypertension can also cause
kidney failure or an
enlarged spleen
resulting in a decrease of blood cells and the development of
anemia, increased
risk of infection and bleeding.
- In advanced cirrhosis, liver failure also results in decreased production
of clotting factors. This causes abnormalities in blood clotting and sometimes
spontaneous bleeding.
- Patients with advanced cirrhosis often develop jaundice because the damaged
liver is unable to eliminate a yellow compound, called
bilirubin.
Hepatitis B virus and primary liver cancer
(hepatocellular carcinoma)
Patients with chronic hepatitis B are at risk of developing
liver cancer. The
way in which the cancer develops is not fully understood. Symptoms of liver
cancer are nonspecific. Patients may have no symptoms, or they may experience
abdominal pain and swelling, an enlarged liver, weight loss, and fever. The most
useful diagnostic screening tests for liver cancer are a blood test for a
protein produced by the cancer called alpha-fetoprotein and
an ultrasound
imaging study of the liver. These two tests are used to screen patients with
chronic hepatitis B, especially if they have cirrhosis or a family history of
liver cancer.
Hepatitis B virus involvement of organs outside of the liver (extra-hepatic)
Rarely, chronic hepatitis B infection can lead to disorders that affect
organs other than the liver. These conditions are caused when the normal immune
response to hepatitis B mistakenly attacks uninfected organs.
Among these conditions are:
- Polyarteritis nodosa: a
disease characterized by inflammation of the small blood vessels throughout the
body. This condition can cause a wide range of symptoms, including muscle
weakness, nerve damage, deep skin ulcers, kidney problems,
high blood pressure,
unexplained fevers, and abdominal pain.
- Glomerulonephritis: another rare condition, which is inflammation of the
small filtering units of the kidney.
Next: How is hepatitis B diagnosed? »
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