The clinical picture is extremely variable, ranging from asymptomatic infection without jaundice to a fulminating disease and death in a few days.Prodromal phase. The speed of onset varies from abrupt to insidious, with general malaise, myalgia, arthralgia and occasionally arthritis, easy fatigability, upper respiratory symptoms (nasal discharge, pharyngitis), and severe anorexia out of proportion to the degree of illness. Nausea and vomiting are frequent and diarrhea or constipation may occur. Fever is generally present but is rarely over 39.5 degrees centigrade. Defervescence often coincides with the onset of jaundice. Chills or chilliness may mark an acute onset.
Abdominal pain is usually mild and constant in the upper right quadrant or right epigastrium and is often aggravated by jarring or exertion. On rare occasions, upper abdominal pain may be severe enough to stimulate cholecystitis or cholelithiasis. A distaste for smoking, paralleling anorexia, may occur early.
Icteric phase. Clinical jaundice occurs after 5 to 10 days but may appear at the same time as the initial symptomatology. Some patients never develop clinical icterus. With the onset of jaundice, there is often an intensification of the prodromal symptoms, followed by progressive clinical improvement.
Convalescent phase. There is an increasing sense of well-being, return of appetite and disappearance of jaundice, abdominal pain and tenderness and fatigability.
Essentials of diagnosis in Western medicine. Anorexia, nausea, vomiting, malaise, symptoms of upper respiratory throatinfection or "flu"-like syndrome, aversion to smoking. Fever, enlarged tender liver and jaundice.Normal to low white cell count; abnormal liver tests and liver function. Liver biopsy shows characteristic hepatocellular necrosis and mononuclear infiltrate.
In traditional Chinese medicine, the signs such as yellow-brown pigmentation of the skin and sclera and yellow coloured urine are also considered in making diagnosis.
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