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Symptoms of hepatitis A
Medical expert of the article
Last reviewed: 06.07.2025
In the typical course of hepatitis A, there is a clearly expressed cyclicity with a sequential change of five periods: incubation, initial, or prodromal (pre-icteric), peak (icteric), post-icteric and the recovery period.
The incubation period lasts from 10 to 45 days, usually 15-30 days. During this period, there are no symptoms of hepatitis A in children, but the viral antigen and high activity of liver cell enzymes (ALT, aspartic transaminase [AST], etc.) can already be detected in the blood.
[ Initial (prodromal) period of hepatitis A
In most children, the disease begins acutely, with a rise in body temperature to 38-39 °C and the appearance of symptoms of intoxication: malaise, weakness, headache, loss of appetite, nausea and vomiting. Pain occurs in the right hypochondrium, in the epigastrium or without a specific localization.
Children become capricious, irritable, lose interest in games, studies, and have sleep disturbances. Transient dyspeptic disorders often occur: flatulence, constipation, and, less commonly, diarrhea.
After 1-2, less often after 3 days from the onset of the disease, body temperature normalizes and the symptoms of intoxication weaken somewhat, but general weakness, anorexia, and nausea persist.
The most important objective symptom in this period of the disease is an enlarged liver, its sensitivity and pain upon palpation.
In isolated cases, the spleen is palpated. By the end of the pre-icteric period, partial discoloration of the feces (clay color) is observed.
In some children, the clinical manifestations of the initial period are weakly expressed or absent altogether, the disease begins immediately with a change in the color of urine and feces. This onset of hepatitis usually occurs in mild and mild forms of the disease.
The duration of the prodromal (pre-icteric) period in hepatitis A is 3-8 days, on average 6±2 days, rarely it is extended to 9-12 days or shortened to 1-2 days.
The peak period (icteric period) of hepatitis A
The transition to the third period usually occurs with a distinct improvement in the general condition and a reduction in complaints. With the appearance of jaundice, the general condition of half of the patients can be assessed as satisfactory, in the other half - as moderately severe for another 2-3 days of the icteric period. At first, yellowness of the sclera appears, and then - the skin of the face, trunk, hard and soft palate, later - the extremities. Jaundice increases quickly, within 1-2 days, often the patient turns yellow as if "overnight".
In terms of intensity, jaundice in hepatitis A can be mild, moderate or intense and lasts for 7-14 days, usually 9-13 days, and persists longest in the folds of the skin, auricles and especially on the sclera in the form of marginal icterus of the sclera.
At the height of jaundice, the liver size is maximally enlarged. The edge of the liver is compacted, rounded, painful on palpation. The edge of the spleen is often palpated.
Changes in other organs with hepatitis A are weakly expressed. One can only note moderate bradycardia, some decrease in blood pressure, weakening of heart tones, impurity of the first tone or a slight systolic murmur at the apex, a slight accent of the second tone on the pulmonary artery, there are short-term extrasystoles.
After reaching the maximum level (usually on the 7-10th day from the onset of the disease), jaundice begins to weaken.
This is accompanied by complete disappearance of intoxication symptoms, improved appetite, significant increase in diuresis (polyuria), bile pigments disappear in the urine and urobilin bodies appear, feces are colored. With a cyclic course of the disease, the period of decline in clinical manifestations occurs within 7-10 days.
Posticteric period of hepatitis A
Characterized by a relatively slow decrease in liver size. Children feel quite healthy, but in addition to an increase in liver size, and in rare cases, the spleen, their functional liver tests remain pathologically altered.
Recovery period, or convalescence period of hepatitis A
In most children, it is accompanied by normalization of liver size, restoration of its functions and a completely satisfactory condition. In some cases, children complain of rapid fatigue during physical exertion, abdominal pain; sometimes a slight enlargement of the liver, dysproteinemia, episodic or constant slight increase in the activity of liver-cell enzymes remain. These symptoms of hepatitis A in children are observed in isolation or in various combinations. The recovery period takes about 2-3 months.
Classification of Hepatitis A in Children
Hepatitis A is classified by type, severity and course.
Typical cases include all cases with the appearance of yellowish coloration of the skin and visible mucous membranes. According to severity, mild, moderate and severe forms are distinguished. An atypical case (anicteric, erased, subclinical hepatitis) is not divided by severity, since it is always regarded as mild hepatitis.
The severity of the clinical form of the disease is assessed in the initial period, but not earlier than the maximum clinical symptoms of viral hepatitis; in this case, the manifestations of the initial (pre-icteric) period are also taken into account.
When assessing the severity, the severity of general intoxication, jaundice, and the results of biochemical studies are taken into account.