Approximately 50% of hepatitis A virus infections have no or only discrete symptoms and leave no health consequences.
The other 50% of sufferers get the following symptoms of viral hepatitis, which can occur in all forms, but the fulminant course is extremely rare. The manifestation of the disease follows an approximately two-week prodromal stage (the patient has become infected, but the virus causes no complaints).
When the disease begins, the patient initially complains of nonspecific general symptoms such as tiredness, fatigue, headache, muscle and joint complaints. This is accompanied by loss of appetite, nausea, vomiting and weight loss.
Symptoms such as pressure in the right upper abdomen can be caused by an enlargement of the liver (liver edema), and by the associated organ capsule tension. The hepatitis A virus can sometimes cause fever because of an infectious cause.
Following this, jaundice (jaundice) and its concomitant symptoms may develop. The billirubin ( bile pigment) can no longer be excreted into the bile ducts of the affected liver cells (hepatocytes). The result is a typical symptom complex of jaundice: a yellowing of the skin and the white eye color are the most striking and obvious symptom of jaundice. An agonizing itching, due to deposited bile salts in the skin, is particularly unpleasant for the patient. In addition, there is a clay-like discoloration of the stool, by the absence of bile pigment in the stool and a darkening of the urine, as the kidney takes over the excretion of bile pigments now. Due to the lack of bile acids in the small intestine, fats can be poorly digested, which can lead to intolerance to high-fat meals and to steatorrhea.
The patients are infectious about 2 weeks before and about 12 weeks after the onset of illness (carriers of the disease). Rarely, some patients experience a recurrence (recurrence) of the disease during this healing period. 99% of HAV infections heal without consequences. In the remaining cases, fulminant liver failure or protracted gall-thickening (cholestatic) courses can occur. Chronification of hepatitis A as in hepatitis B and C has never been described.
At the beginning of an infection with hepatitis A virus, non-specific, grippal symptoms often occur.
This can be accompanied by fever, which can occur again and again in the course of the disease. In addition, the patients report a subjective feeling of sickness with severe fatigue, tiredness and fatigue.
Jaundice ( jaundice ) is probably the most well-known symptom of hepatitis disease.
However, it often occurs only in the advanced stage of the disease after several weeks or months. The inflammation of the liver tissue disturbs the metabolism of bilirubin. The resulting bilirubin is thus metabolized to various intermediates and can be deposited in the skin and in the mucous membranes.
This leads to a yellowing of the skin with increasing concentration and can concomitantly cause a strong itching. It often comes first to a yellowing of the leather skins of the eyes and only with increasing bilirubin levels to a yellowing of the skin. Characteristically, the skin in the head and neck area is affected before the skin in the area of the chest, abdomen and extremities turns yellow.
A common symptom in the early stages of the disease is the increased loss of appetite.
This can occur just a few weeks after infection with the virus. In part, the loss of appetite is also directed against certain foods.
Other, often occurring in the early stages of the disease, are nausea and vomiting.
The nausea often accompanies a general fatigue, loss of appetite and fever. In rare cases nausea and vomiting are also directed against certain foods. These are often meat and very greasy products.
The inflammation of the liver tissue disturbs the metabolism of bilirubin.
The daily bilirubin can therefore not be excreted via the biliary tract and the intestine and accumulates in the blood. As a result, the water-soluble bilirubin is eliminated via the kidneys. There it leads to a darkening of the urine.
At the same time it comes through the disturbed bilirubin metabolism also to a changed bowel movement.
Normally, bilirubin metabolised in the liver passes through the bile ducts into the intestine, where it is broken down into further bilirubin derivatives. These are responsible for the characteristic staining of the stool. However, when liver function is limited due to hepatitis inflammation, bilirubin does not pass through the bile ducts in the intestine. As a result, there is a discoloration of the chair - it is called a clay chair.
Another characteristic symptom of liver inflammation ( hepatitis ) is pain in the right upper abdomen.
While the liver tissue itself is not supplied by sensory nerve fibers, the surrounding liver capsule contains numerous nerve fibers. Inflammation causes tension in the liver capsule and in some cases a very strong, dull pressure pain below the right costal arch.