Doctor's Notes on Hepatitis A
(HAV, Hep A)
Hepatitis A is a disease characterized by inflammation of the liver. It is caused by and infection with the hepatitis A virus. Hepatitis A virus is spread from person to person by contaminated stools (feces), foods that have been touched or prepared by an infected person, and close personal contact with an infected person, or contaminated water. It is not spread by coughing, sneezing, or being near an infected person.
People can be infected with hepatitis A and not show any symptoms. When they do occur, symptoms of hepatitis A can include fever, chills, fatigue, stomach discomfort, loss of appetite, and diarrhea. Other associated signs and symptoms can include light-colored stools, dark yellow urine, and yellowing of the whites of the eyes and skin (known as jaundice).
(HAV, Hep A) Symptoms
- Many people with HAV infection have no symptoms at all.
- Sometimes symptoms are so mild that they go unnoticed.
- Older people are more likely to have symptoms than children.
- People who do not have symptoms can still spread the virus so it is difficult to know when a person has been exposed to the virus.
Symptoms of hepatitis A usually develop between 2 and 6 weeks after infection. The symptoms are usually not too severe and go away on their own, over time. The most common symptoms are as follows:
- Diarrhea, especially in children
- Pale or gray-colored stools
- Low-grade fever
- Loss of appetite
- Tiredness, fatigue
- Jaundice (a yellow discoloration of the skin and the whites of the eyes, see image below)
- Urine is dark brownish in color, like cola or strong tea.
- Pain in the area of the liver, on the right side of the abdomen just under the rib cage
Picture of Jaundice (yellowing of the skin and the whites of the eyes)
Photo courtesy of the Centers for Disease Control and Prevention
If the vomiting is severe, dehydration may occur. Dehydration may become serious and life-threatening in some affected individuals, so symptoms of dehydration need to be quickly addressed, often by a medical caregiver. Symptoms of dehydration include the following:
- Feeling weak or tired
- Feeling confused or unable to concentrate
- Rapid heartbeat
- Urinating less frequently than usual
Symptoms of hepatitis A infection usually last less than 2 months, although they may last as long as 9 months. Some people infected with hepatitis A have symptoms that come and go for 6-9 months.
(HAV, Hep A) Causes
The cause of hepatitis A is hepatitis A virus (HAV) that is transmitted person to person by contaminated foods, water or other drinks (including ice), blood, stool, and direct contact. The virus is a Picornavirus that contains single-stranded RNA as its genome covered by a protein shell. The virus enters through the epithelium in the mouth or gut and migrates to the liver over a period of about two to six weeks. Symptoms (jaundice and other symptoms, see below) then begin to develop as the virus replicates in the liver cells (hepatocytes and Kupffer cells, also termed liver macrophages). HAV reproduces itself by utilizing the liver cell's ribosomes for viral replication; however this interferes with normal liver cell function. If large numbers of liver cells are infected with HAV, the person will develop symptoms. The viruses are secreted into the GI tract by the bile fluid made in the liver. The majority of people infected recover with no lasting damage to the liver.
Hepatitis A Virus (HAV) Courtesy of the CDC
Inflammation of the liver of any cause is referred to as hepatitis. It may be caused by viruses, drugs, or alcohol, although the most common cause is viruses, viral hepatitis. There are several types of viral hepatitis, the most common of which are hepatitis A, B, and C.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.