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Hepatitis B - Management
When should I suspect chronic hepatitis B?

  • Symptoms and signs of chronic hepatitis B infection are often absent.
  • When present, symptoms are usually mild and non-specific.
    • Fatigue or loss of appetite are common.
    • Nausea, discomfort in the right upper abdominal quadrant, myalgia, and arthralgia also occur.
  • Occasionally, chronic hepatitis B presents with extrahepatic manifestations (such as glomerulonephritis, vasculitis, and polyarteritis).
  • Signs of chronic liver disease may develop in the longer term.
    • These include spider naevi, finger clubbing, jaundice, and hepatosplenomegaly.
    • If advanced cirrhosis develops, there may be:
      • Easy bruising.
      • Oedema and abdominal swelling (ascites).
      • Liver flap and encephalopathy.
      • Progressive weight loss, muscle wasting, and weakness.
      • Progressive jaundice.
  • People with chronic hepatitis B may also be identified:
    • Following screening tests for people at high risk.
    • Through follow up, after a diagnosis of acute hepatitis B.
    • Because of abnormal liver function tests.
      • The most common abnormalities are mild increases in levels of ALT (alanine transaminase) and AST (aspartate transaminase).
      • ALT levels may be only mildly elevated (less than 100 IU/L); the progression to chronic infection is indicated when this persists for more than 6 months after acute hepatitis B.
      • Alkaline phosphatase levels tend to be normal (or nearly normal).
      • Bilirubin and albumin levels, and prothrombin time, are usually normal (unless liver disease is severe and advanced).

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