Symptoms of viral hepatitis in the elderly

Viral hepatitis is a type of hepatitis, and for humans, the infection rate of viral hepatitis is still very high. In fact, most of them are caused by diet. The incidence of viral hepatitis is also very high among the elderly. So, what are the symptoms of viral hepatitis in the elderly? This is generally unknown to people who are not in related professions or have not done in-depth research, and this is also very normal.

Everyone knows that the physical fitness of the general elderly is relatively poor. Of course, in reality there are still a small number of elderly people who are still quite strong for various reasons, but they are only a minority. Generally, elderly people get sick frequently, even if it is just a cold, this happens several times a year. Strictly speaking, viral hepatitis is also a common disease among the elderly. So, let’s talk about the symptoms of viral hepatitis in the elderly.

According to the viral hepatitis prevention and treatment plan, hepatitis can be divided into 5 clinical types.

1. Acute hepatitis

It is divided into acute icteric hepatitis and acute non-icteric hepatitis. The incubation period is between 15 and 45 days, with an average of 25 days, and the total course of the disease is 2 to 4 months.

(1) In the early stage of jaundice, there are chills, fever, fatigue, loss of appetite, nausea, aversion to oily food, abdominal discomfort, pain in the liver area, and the urine color gradually darkens. This stage lasts an average of 5 to 7 days.

(2) During the jaundice phase, the fever subsides, the sclera and skin turn yellow, jaundice appears and the subjective symptoms improve. The liver is enlarged with tenderness and percussion pain, and some patients have mild splenomegaly. This phase lasts 2 to 6 weeks.

(3) During the recovery period, jaundice gradually subsides, symptoms are alleviated or even disappear, the liver and spleen shrink, and liver function gradually returns to normal. This period lasts from 2 weeks to 4 months, with an average of 1 month.

2. Chronic hepatitis

Patients with a history of hepatitis B, C, D or HBsAg carriage or acute hepatitis course of more than half a year who still have hepatitis symptoms, signs and abnormal liver function can be diagnosed with chronic hepatitis. Common symptoms include fatigue, general discomfort, loss of appetite, discomfort or pain in the liver area, abdominal distension, and low fever. Physical signs include dull complexion, jaundice of the sclera, spider angiomas or liver palms, enlarged liver, medium or full texture, anterior pressure and percussion tenderness, and often splenomegaly. In severe cases, there may be worsening jaundice, ascites, lower limb edema, bleeding tendency and hepatic encephalopathy. To reflect the degree of liver damage, clinical diagnosis can be divided into:

(1) Mild disease refers to mild symptoms with no obvious symptoms or symptoms and signs but only 1 to 2 biochemical indicators are slightly abnormal.

(2) Moderate symptoms, signs, and laboratory tests are between mild and severe.

(3) Severe cases include obvious or persistent symptoms of hepatitis, such as fatigue, poor appetite, abdominal distension, loose stools, etc. Patients may have liver disease facial complexion, liver palms, spider nevi or hepatosplenomegaly, and other causes are excluded and there is no portal hypertension. Laboratory examinations show repeated or persistent elevation of serum alanine aminotransferase, decreased albumin or abnormal A/G ratio, and significantly elevated immunoglobulin. Patients with one of the three tests of albumin ≤32g/L, bilirubin >85.5μmol/L, and prothrombin activity 60%-40% can be diagnosed with severe chronic hepatitis.

3. Severe hepatitis

(1) Acute severe hepatitis has an acute onset and rapid progression, with deep jaundice and a small liver. Neuropsychiatric symptoms (hepatic encephalopathy grade II or above) appear rapidly within 10 days after onset, with a significant bleeding tendency, and may also cause liver odor, ascites, and hepatorenal syndrome. If the prothrombin activity is lower than 40% and other causes are excluded, the patient has low cholesterol and obviously abnormal liver function.

(2) Subacute severe hepatitis may still cause extreme fatigue, poor appetite, severe jaundice (bilirubin > 171 μmol/L), abdominal distension and ascites, and obvious bleeding 10 days after onset. The liver is usually not significantly shrunken. Hepatic encephalopathy is more common in the late stage. Liver function is severely damaged: serum ALT is elevated, or the elevation is not obvious while total bilirubin is significantly elevated, that is, bile enzyme separation, A/G ratio is inverted, immunoglobulin G is elevated, prothrombin time is prolonged, and prothrombin activity is <40%.

(3) Chronic severe hepatitis Patients with a history of chronic hepatitis, cirrhosis, or hepatitis B surface antigen carriers, or those without the above medical history but with imaging, laparoscopy, or liver puncture supporting chronic hepatitis symptoms, and who also have clinical manifestations and laboratory changes of subacute severe hepatitis, are classified as having chronic severe hepatitis.

4. Cholestatic hepatitis

The onset is similar to that of acute icteric hepatitis, but the subjective symptoms are often milder, with obvious hepatomegaly, itchy skin, light-colored stools, significant increases in serum alkaline phosphatase, γ-transpeptidase, and cholesterol, deep jaundice, and a mainly direct increase in bilirubin. Gastrointestinal symptoms are not obvious, the increase in transaminases is small, and the prothrombin time and prothrombin activity are normal. It is characterized by milder clinical symptoms and a lack of jaundice.

5. Post-hepatitis cirrhosis

Early liver cirrhosis is difficult to diagnose based on clinical data alone and must rely on pathological diagnosis, imaging diagnosis (ultrasound, CT, etc.) and laparoscopy for the most valuable reference. The clinical diagnosis of cirrhosis refers to the presence of evidence of portal hypertension in patients with chronic hepatitis, such as varices of the abdominal wall and esophagus, ascites, and imaging findings of a shrunken liver, enlarged spleen, and widened internal diameters of the portal and splenic veins, and the exclusion of other causes of portal hypertension. Depending on the degree of hepatitis activity, it is divided into active and dormant cirrhosis.

There are many symptoms of viral hepatitis in the elderly, and the symptoms are generally different according to different types. For example, the symptoms of acute viral hepatitis are generally: nausea, loss of appetite, fatigue, etc.; the common symptoms of chronic viral hepatitis are generally: abdominal distension, liver palms, etc.; and the common symptoms of severe viral hepatitis are: itchy skin, light-colored stools, etc.