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== History and Symptoms==
{{Hepatitis B}}
{{CMG}}; {{AE}} {{JM}}


Sometimes a person with HBV infection has no symptoms at all. The older you are, the more apt you are to have symptoms. You might be infected with HBV (and be spreading the virus) and not know it.
==Overview==


Symptoms might include:
50% of adult patients and the majority of infants and children with acute HBV do not present with symptoms.  Symptoms may initially be non-specific.<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>  Proper and thorough history-taking is important in both acute and chronic HBV infections in order to determine modes of infection transmission, as well as to assess [[risk factors]] for the progression of HBV-related [[liver disease]].<ref name="pmid19399815">{{cite journal| author=Rotman Y, Brown TA, Hoofnagle JH| title=Evaluation of the patient with hepatitis B. | journal=Hepatology | year= 2009 | volume= 49 | issue= 5 Suppl | pages= S22-7 | pmid=19399815 | doi=10.1002/hep.22976 | pmc=PMC2881483 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19399815  }} </ref><ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>


*yellow skin or yellowing of the whites of your eyes ([[jaundice]])  
==History==
*tiredness
Part of the initial evaluation for HBV infection includes a thorough patient history focusing on potential modes and timing of infection.  Aspects covered in the patient's history include:<ref name="pmid19399815">{{cite journal| author=Rotman Y, Brown TA, Hoofnagle JH| title=Evaluation of the patient with hepatitis B. | journal=Hepatology | year= 2009 | volume= 49 | issue= 5 Suppl | pages= S22-7 | pmid=19399815 | doi=10.1002/hep.22976 | pmc=PMC2881483 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19399815  }} </ref>
*loss of appetite
*Exposure to blood and/or blood products
*[[nausea and vomiting]]
*[[Intravenous drug use|Injection drug use]] ([[IDU]])
*abdominal discomfort
*Sexual exposure
*dark urine
*Occupational exposure
*clay-colored bowel movements
*Family history of HBV
*[[joint pain]]
*Recent history of invasive procedures performed in non-hospital health care settings, including [[hemodialysis]] centers and long-term care facilities<ref name="pmid19124818">{{cite journal| author=Thompson ND, Perz JF, Moorman AC, Holmberg SD| title=Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. | journal=Ann Intern Med | year= 2009 | volume= 150 | issue= 1 | pages= 33-9 | pmid=19124818 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19124818  }} </ref>
===Chronic HBV===
In chronic HBV, history taking includes obtaining information regarding factors associated with the progression of HBV-related [[liver disease]].<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>  The following aspects should be covered:<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref><ref name="pmid19399815">{{cite journal| author=Rotman Y, Brown TA, Hoofnagle JH| title=Evaluation of the patient with hepatitis B. | journal=Hepatology | year= 2009 | volume= 49 | issue= 5 Suppl | pages= S22-7 | pmid=19399815 | doi=10.1002/hep.22976 | pmc=PMC2881483 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19399815  }} </ref>
*Risk factors for coinfection with [[HDV]], [[HCV]], and [[HIV]]
*Family history of [[liver disease]] and [[HCC]]
*Medication history
*Smoking status
*Alcohol consumption
*[[Drug abuse]]
*Sexual activity
*History of previous HBV treatment (to assess potential for treatment resistance)
*[[Antiretroviral]] drug regimen if coinfected with [[HIV]] (to assess potential for treatment resistance)


Hepatitis B virus infection may either be acute (self-limited) or chronic (long-standing). Persons with self-limited infection clear the infection spontaneously within weeks to months.
===Patients from Areas of High Endemicity===
History-taking among immigrants from regions with a high prevalence of HBV should include questions regarding family history of acute and/or [[chronic liver disease]], rituals in which shared and non-sterile instruments were used (e.g., scarification, piercing), and traditional medical procedures.<ref name="pmid19399815">{{cite journal| author=Rotman Y, Brown TA, Hoofnagle JH| title=Evaluation of the patient with hepatitis B. | journal=Hepatology | year= 2009 | volume= 49 | issue= 5 Suppl | pages= S22-7 | pmid=19399815 | doi=10.1002/hep.22976 | pmc=PMC2881483 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19399815  }} </ref>


Children are less likely than adults to clear the infection. More than 95% of people who become infected as adults or older children will stage a full recovery and develop protective immunity to the virus. However, only 5% of newborns that acquire the infection from their mother at birth will clear the infection. Of those infected between the age of one to six, 70% will clear the infection. When the infection is not cleared, one becomes a chronic carrier of the virus.
==Symptoms==


Acute infection with hepatitis B virus is associated with acute viral [[hepatitis]] - an illness that begins with general ill-health, loss of appetite, nausea, vomiting, body aches, mild fever, dark urine, and then progresses to development of [[jaundice]]. It has also been noted that itchy skin all over the body has been an indication as a possible symptom of all hepatitis virus types.  The illness lasts for a few weeks and then gradually improves in most affected people. A few patients may have more severe liver disease ([[fulminant hepatic failure]]), and may die as a result of it. The infection may also be entirely asymptomatic and may go unrecognized.
Approximately 50% of adults with acute [[HBV]] infections are [[asymptomatic]]. However, clinical symptoms occur more often in adults than in infants or children, who usually have an asymptomatic, acute course.<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>
   
Symptoms can include:<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>
*[[Fever]]
*[[Fatigue]]
*[[Nausea]]
*[[Vomiting]]
*[[Loss of appetite]]
*[[Abdominal pain]]
*Dark urine
*[[Acholic stools|Clay-colored bowel movements]]
*[[Joint pain]]
*Yellowish discoloration of the eyes and skin
*[[Skin rash]]
*[[Muscle pain]]


Chronic infection with hepatitis B virus may be either asymptomatic or may be associated with a chronic inflammation of the liver (chronic hepatitis), leading to [[cirrhosis]] over a period of several years. This type of infection dramatically increases the incidence of [[liver cancer]].
== References == 
{{Reflist|2}}


[[Hepatitis D]] infection usually only occurs with a concomitant infection with hepatitis B.<ref>Lok A.  [http://www.patients.uptodate.com/topic.asp?file=livertrn/2133 Hepatitis D virus infection and liver transplantation.] uptodate.com. Retrieved on September 11, 2007.</ref> Co-infection with hepatitis D increases the risk of liver cirrhosis and subsequently, liver cancer.


[[Polyarteritis nodosa]] is more common in people with hepatitis B infection.
{{WH}}
{{WS}}


== References == 
[[Category:Gastroenterology]]
{{Reflist|2}}
[[Category:FinalQCRequired]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Hepatology]]

Latest revision as of 22:04, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2]

Overview

50% of adult patients and the majority of infants and children with acute HBV do not present with symptoms. Symptoms may initially be non-specific.[1] Proper and thorough history-taking is important in both acute and chronic HBV infections in order to determine modes of infection transmission, as well as to assess risk factors for the progression of HBV-related liver disease.[2][3]

History

Part of the initial evaluation for HBV infection includes a thorough patient history focusing on potential modes and timing of infection. Aspects covered in the patient's history include:[2]

  • Exposure to blood and/or blood products
  • Injection drug use (IDU)
  • Sexual exposure
  • Occupational exposure
  • Family history of HBV
  • Recent history of invasive procedures performed in non-hospital health care settings, including hemodialysis centers and long-term care facilities[4]

Chronic HBV

In chronic HBV, history taking includes obtaining information regarding factors associated with the progression of HBV-related liver disease.[3] The following aspects should be covered:[3][2]

  • Risk factors for coinfection with HDV, HCV, and HIV
  • Family history of liver disease and HCC
  • Medication history
  • Smoking status
  • Alcohol consumption
  • Drug abuse
  • Sexual activity
  • History of previous HBV treatment (to assess potential for treatment resistance)
  • Antiretroviral drug regimen if coinfected with HIV (to assess potential for treatment resistance)

Patients from Areas of High Endemicity

History-taking among immigrants from regions with a high prevalence of HBV should include questions regarding family history of acute and/or chronic liver disease, rituals in which shared and non-sterile instruments were used (e.g., scarification, piercing), and traditional medical procedures.[2]

Symptoms

Approximately 50% of adults with acute HBV infections are asymptomatic. However, clinical symptoms occur more often in adults than in infants or children, who usually have an asymptomatic, acute course.[1]

Symptoms can include:[1]

References

  1. ↑ 1.0 1.1 1.2 Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html
  2. ↑ 2.0 2.1 2.2 2.3 Rotman Y, Brown TA, Hoofnagle JH (2009). "Evaluation of the patient with hepatitis B." Hepatology. 49 (5 Suppl): S22–7. doi:10.1002/hep.22976. PMC 2881483. PMID 19399815.
  3. ↑ 3.0 3.1 3.2 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.
  4. ↑ Thompson ND, Perz JF, Moorman AC, Holmberg SD (2009). "Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008". Ann Intern Med. 150 (1): 33–9. PMID 19124818.


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