Hepatitis B is a serious viral infection that affects the liver, leading to both acute and chronic inflammation. Globally, more than 296 million people live with chronic Hepatitis B, and it remains a major public health threat due to its association with cirrhosis and hepatocellular carcinoma (HCC).
This article focuses on the clinical presentation of Hepatitis B, using the JAUNDICE FEVER mnemonic as a memory aid. This tool is extremely useful for students, doctors, and health workers in recalling the symptomatic profile of this liver disease and differentiating it from other types of hepatitis.
What is Hepatitis B?
Hepatitis B is a DNA virus belonging to the Hepadnaviridae family. It primarily infects hepatocytes, leading to varying degrees of liver inflammation.
Transmission Routes
| Mode of Transmission | Examples |
|---|---|
| Parenteral (bloodborne) | Needle sharing, transfusion, dialysis |
| Sexual | Unprotected intercourse |
| Perinatal | Mother-to-child during childbirth |
| Horizontal (less common) | Close household contact, saliva |
Note: Hepatitis B is 50–100 times more infectious than HIV.
Mnemonic: “JAUNDICE FEVER” for Hepatitis B Symptoms
The image summarizes the clinical features of Hepatitis B using the mnemonic JAUNDICE FEVER, which we will now explore in detail:
J – Jaundice
- Yellowish discoloration of the skin, sclera (eyes), and mucous membranes.
- Caused by elevated bilirubin due to impaired hepatic metabolism.
- Usually appears after prodromal symptoms and is more pronounced in adults.
A – Abdominal Pain
- Localized to the right upper quadrant (RUQ).
- May radiate to the back or shoulder.
- Due to liver inflammation and hepatic capsule stretching.
U – Urine Problems (Dark Urine)
Urine becomes tea-colored or dark brown due to:- Elevated conjugated bilirubin excreted in the urine.
- Indicates cholestasis or biliary involvement.
N – Nausea
- Common in the prodromal phase.
- Accompanied by anorexia, aversion to food, and early satiety.
- Affects overall nutritional status and hydration.
D – Dark Urine (Repeated for emphasis)
- A hallmark of hepatic dysfunction.
- Different from hematuria (blood in urine); here, the discoloration is due to pigment bilirubinuria.
I – Indigestion
- Includes bloating, discomfort, and poor appetite.
- Often reported in early stages or mild infections.
- May mimic gastritis or peptic ulcer disease.
C – Collection of Fluid in Abdomen (Ascites)
- Seen in chronic Hepatitis B or cirrhosis.
- Fluid builds up due to portal hypertension and hypoalbuminemia.
- Presents with abdominal distension, shifting dullness, and pitting edema.
E – Eyes Yellow (Scleral Icterus)
- One of the first visible signs of jaundice.
- Easily noted in natural light.
- Often used as a screening sign in clinical settings.
The “FEVER” Continuation
F – Fever / Fatigue
Low-grade fever may be present in the prodromal stage.
Fatigue is due to:- Liver inflammation
- Reduced detoxification
- Immune system activation
E – Excessive Weakness
- Systemic symptom common in viral illnesses.
- Due to muscle breakdown, poor nutrition, and catabolic state.
V – Vomiting
- May precede jaundice and occur with nausea.
- Persistent vomiting may lead to dehydration and electrolyte imbalance.
E – Excessive Malaise
- Feeling of general unease, tiredness, and lack of motivation.
- Reflects cytokine storm and ongoing viral activity.
R – Regurgitation
- Though not classical, some patients complain of acid reflux, belching, or epigastric discomfort.
- Could be secondary to gastritis or hepatomegaly-induced gastric compression.
Stages of Hepatitis B Clinical Progression
| Stage | Description |
|---|---|
| Incubation Period | 1 to 6 months; virus replicates silently |
| Prodromal (Pre-icteric) | Fever, malaise, anorexia, nausea |
| Icteric Phase | Jaundice, dark urine, RUQ pain, hepatomegaly |
| Convalescent Phase | Gradual symptom resolution, viral clearance (if acute) |
Laboratory Features of Hepatitis B
| Test | Result in Active Infection |
|---|---|
| HBsAg (Surface Antigen) | Positive in acute or chronic infection |
| Anti-HBc IgM | Indicates recent infection |
| Anti-HBc IgG | Past or chronic infection |
| HBeAg | Active viral replication |
| ALT / AST | Elevated (>10x normal) |
| Bilirubin | Raised in icteric phase |
| Prothrombin Time | May be prolonged in fulminant cases |
Differentiating Acute vs Chronic Hepatitis B
| Feature | Acute Infection | Chronic Infection |
|---|---|---|
| Duration | <6 months | >6 months |
| Jaundice | Common | May be absent |
| HBsAg | Temporary | Persistent |
| ALT/AST | Elevated | May fluctuate |
| Cirrhosis Risk | Low | High |
| HCC Risk | Minimal | Significant (especially with HBV DNA >2000 IU/mL) |
Complications of Chronic Hepatitis B
- Liver Cirrhosis
- Hepatocellular Carcinoma (HCC)
- Portal Hypertension
- Liver Failure
- Co-infections (HIV, Hepatitis D)
Hepatitis B Treatment Overview
Acute Hepatitis B
- Supportive care only in most cases.
- Hydration, rest, antiemetics, and nutritional support.
Chronic Hepatitis B
Antiviral therapy indicated in:
- Elevated HBV DNA
- Elevated ALT
- Liver damage or fibrosis on biopsy
First-Line Antivirals:
- Tenofovir
- Entecavir
- Pegylated interferon-alpha (in some cases)
Hepatitis B Prevention
Vaccination: Given in 3 doses (0, 1, 6 months).
Safe practices:
- Avoid needle sharing
- Use condoms
- Screen blood donations
Post-exposure prophylaxis:
- HBV vaccine + Hepatitis B Immune Globulin (HBIG) within 24 hours
Hepatitis B vs Hepatitis A, C, D, E
| Feature | Hep A | Hep B | Hep C | Hep D | Hep E |
|---|---|---|---|---|---|
| Transmission | Feco-oral | Blood, sex | Blood | Co-infection with B | Feco-oral |
| Chronic Disease | No | Yes | Yes | Yes | Rare |
| Vaccine Available | Yes | Yes | No | No | No |
| Risk of HCC | No | Yes | Yes | Yes | No |
Case Study: Real-life Example
Patient: 34-year-old man with fatigue, yellow eyes, dark urine, and nausea for 2 weeks.
Findings:
- ALT: 1450 U/L
- HBsAg: Positive
- Anti-HBc IgM: Positive
Diagnosis: Acute Hepatitis B
Treatment: Supportive care, nutrition, hydration, monitoring for complications
FAQs on Hepatitis B Symptoms
Q1. Can Hepatitis B be asymptomatic?
Yes. Many people, especially children, may carry the virus silently, which is why screening is crucial.
Q2. Is jaundice always present?
No. Some patients, especially in chronic cases, may not develop jaundice at all.
Q3. Can symptoms be reversed with treatment?
Yes, acute symptoms usually resolve with rest. Chronic symptoms may improve with antivirals, but fibrosis/cirrhosis may be permanent.
Q4. Are gastrointestinal symptoms common?
Yes. Nausea, vomiting, regurgitation, and indigestion are frequently reported.
Q5. What symptom warrants urgent medical attention?
- Altered mental status
- Bleeding (e.g., gums, stools)
- Sudden abdominal distension
These suggest fulminant hepatitis or liver failure.
