Hepatitis B

The symptoms of acute hepatitis B include:

• Yellowing of skin and the 'whites' of the eyeball (sclera ) known as jaundice
• Joint pain
• Rash which may be itchy
• Fever
• Pain over the right upper abdomen
• Dark tea-coloured urine
• Nausea, loss of appetite and vomiting

Treatment in the acute period of the illness is essentially symptomatic relief of symptoms like itch, nausea and vomiting. It is generally advisable for patients with severe symptoms or deep jaundice to be admitted to hospital for observation because of the potentially severe consequences (fulminant hepatitis ) which may prove to be fatal, albeit rarely. This enables rapid intervention, which may be lifesaving, to be instituted if required. The patient is advised bedrest, and avoidance of alcohol and traditional Chinese remedies which could exacerbate his condition.

Different Phases of Chronic Hepatitis B

A chronic hepatitis B carrier goes through 3 phases, especially if the infection is acquired at birth. This is the usual scenario amongst carriers in Singapore:

• High viral replicative ( immune-tolerant ) phase which is usually seen in patients less than 20 year old. There is rapid viral replication but the patient is well and has no symptoms. Blood tests and liver samples indicate minimal liver inflammation.
• Low viral replicative (immune-elimination ) phase which occurs in patients between 20 to 40 years old. In this phase, the body's immune system attempts to rid itself of the hepatitis B virus, and this is reflected by abnormal blood tests that indicates active liver inflammation. The carrier may complain of lethargy. Occasionally, if this phase occurs in older patients, especially if more than 60 years, the clinical course is more serious and can cause severe liver dysfunction and death.
• Non-replicative ( latent infection ) phase occurs in carriers above the age of 40 years. This phase is characterised by the continuous presence of the hepatitis B virus with a low replicative rate. There may be however, evidence of liver damage which later progresses on to liver cancer. The patient in this last phase may present for the first time with swelling of legs and abdomen, progressive mental deterioration and vomiting or passing out of blood in the stools.