Hepatitis A symptoms
Last reviewed: 23.04.2024
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With a typical course of hepatitis A, the cycle is clearly marked with a successive change of five periods: incubation, initial, or prodromal (pre-zheltushnogo), high (icteric), post-jelly and period of convalescence.
The incubation period lasts from 10 to 45 days, usually 15-30 days. In this period, the symptoms of hepatitis A in children are absent, but in the blood it is already possible to detect a viral antigen and a high activity of liver-cell enzymes (ALT, aspartic transaminase [ACT], etc.).
[The initial (prodromal) period of hepatitis A
The disease in most children begins acutely, with a rise in body temperature to 38-39 ° C and the appearance of symptoms of intoxication: malaise, weakness, headache, decreased appetite, nausea and vomiting. There are pains in the right hypochondrium, in epigastrium or without a certain localization.
Children become capricious, irritable, lose interest in games, studies, they are disturbed by sleep. Often there are rapidly dyspeptic disorders: flatulence, constipation, and, more rarely, diarrhea.
1-2, less than 3 days after the onset of the disease, the body temperature is normalized and the symptoms of intoxication somewhat weaken, but general weakness, anorexia, nausea remain.
The most important objective symptom in this period of the disease is an increase in the liver, its sensitivity and soreness in palpation.
In isolated cases, the spleen is palpable. By the end of the pre-jaundiced period, partial decoloration of the stool (clay color) is observed.
In some children, the clinical manifestations of the initial period are mild or nonexistent, the disease begins immediately with a change in the color of urine and feces. Such a onset of hepatitis usually occurs with mild and lightest forms of the disease.
The duration of the prodromal (pre-jaundiced) period with hepatitis A is 3-8 days, on average 6 ± 2 days, rarely it lengthens to 9-12 days or is shortened to 1-2 days.
The period of high blood pressure (icteric period) of hepatitis A
The transition to the third period usually occurs when the apparent improvement in the overall condition and the reduction of complaints begin. With the appearance of jaundice, the general condition in half of patients can be regarded as satisfactory, in the other half - as an average for another 2-3 days of icteric period. In the beginning appears jaundice sclera, and then - skin of the face, trunk, firm and soft palate, later - limbs. Jaundice increases rapidly, within 1-2 days, often the patient turns yellow "as one night".
The intensity of jaundice in hepatitis A is mild, moderate or intense and lasts for 7-14 days, usually 9-13 days, lasts longer in the folds of the skin, the auricles and especially on the sclera in the form of a marginal icteric sclera.
At the height of jaundice, the liver is maximally enlarged. The margin of the liver becomes denser, rounded, and painful when palpated. Often, the edge of the spleen is palpable.
Changes from other organs with hepatitis A are mild. You can only note a moderate bradycardia, a slight decrease in blood pressure, a weakening of heart sounds, impurity of the first tone or slight systolic noise at the top, a slight accent of the second tone on the pulmonary artery, there are short-term extrasystoles.
After reaching the maximum level (usually on the 7-10th day from the onset of the disease), jaundice begins to weaken.
This is accompanied by the complete disappearance of symptoms of intoxication, improvement in appetite, a significant increase in diuresis (polyuria), bile pigments disappear in the urine and urobilin bodies appear, feces stain. With the cyclical course of the disease, the period of decline in clinical manifestations occurs within 7-10 days.
The post-alcoholic period of hepatitis A
It is characterized by a relatively slow decrease in liver size. Children feel completely healthy, but they have, in addition to increasing the size of the liver, and in rare cases, the spleen, are pathologically altered functional liver tests.
The recovery period, or the period of convalescence of hepatitis A
Most children are accompanied by normalization of liver size, restoration of its functions and a completely satisfactory condition. In some cases, children complain of rapid fatigue with physical activity, abdominal pain; sometimes there is a small increase in the liver, the phenomenon of disproteinemia, episodic or persistent insignificant increase in the activity of liver-cell enzymes. These symptoms of hepatitis A in children are observed in isolation or in various combinations. The period of convalescence takes about 2-3 months.
Classification of hepatitis A in children
Hepatitis A is classified by type, severity and course.
Typical include all cases with the appearance of icteric staining of the skin and visible mucous membranes. By gravity distinguish light, medium and heavy forms. Atypical case (jaundiced, erased, subclinical hepatitis) is not divided by severity, as it is always regarded as a mild hepatitis.
The severity of the clinical form of the disease is assessed in the initial period, but not before the maximum of the clinical symptoms of viral hepatitis; while taking into account the manifestations of the initial (pre-yellow) period.
When assessing the severity, take into account the severity of general intoxication, jaundice, as well as the results of biochemical studies.