Infection of the liver by the hepatitis A or B virus brings about an inflammation of the hepatocytes (Liver cells) and hyperplasia

(excessive multiplication) of the Kupffers cells of the liver. This process of inflammation leads to the dilatation of the blood vessels of the liver making them more permeable. Increased permeability leads to increase supply of blood to the area. Extravasation into the liver tissue causes hepatomegaly (enlargement of the liver). A steady upper abdominal pain is produced as a result of the stretching of the peritoneum over the liver following the enlargement of the liver. The swelling of the liver cells leads to obstruction of the bile canaliculi, bringing about accumulation of bile (cholestasis). Bile salts are reabsorbed into circulation thereby causing pruritus (great irritation of the skin). Non-specific gastrointestinal symptoms such as anorexia, nausea, vomiting, flatulence, constipation, or diarrhea are produced as a result of a disruption in portal circulation. The inflammatory process also causes the death of the hepatocytes and the liver parenchyma which subsequently brings about necrosis (death of portion of the liver). Systemic response to inflammation includes malaise, headache, chills, fatigue, lassitude and weight loss. There is cholestasis as a result of obstruction to bile flow. This brings about obstructive jaundice. The obstruction leads to less bilirubin being conjugated. This leads to the excretion of the characteristic claycoloured stool. Dark coloured urine is also passed as a result of the absorption of excess bilirubin into circulation. Signs and symptoms of hepatitis 1. Abdominal pain (in the right upper quadrant) 2. Jaundice 3. Liver tenderness 4. Enlargement of the liver (hepatomegaly) 5. Irritation of the skin (pruritus) 6. Dark coloured urine 7. Clay coloured stool 8. Nausea and vomiting 9. Loss of appetite (anorexia) 10. Diarrhea or constipation 11. Weight loss 12. Fever 13. Flatulence (gas in the stomach) 14. Melaena (blood in stool) 15. Fatigue 16. Irritability Diagnosis 1. Urine bilirubin: Urine specimen will show an elevated level of urobilinogen. Bilirubin appears later on in the urine. 2. Stool test: In case of hepatitis A, faecal specimen will contain hepatitis A virus. 3. Blood: Hepatitis A and B antigens and their associated antibodies would be present in blood samples. 4. Serum enzyme test: This will show a high level of Serum Glutamic Pyruvic Transaminase (SGPT) an enzyme excreted by the parenchyma cells of the liver. Serum test also shows a marked elevation in the level of Serum Glutamic Oxalacetic Transaminase (SGOT), and serum bilirubin. Prothrombin time is also raised.