Hepatitis E Clinical Presentation

Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC; Chief Editor: Julian Katz, MD more...

Updated: Jan 3, 2012

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History
Physical Examination
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History

The incubation period ranges from 15 days to 60 days. The course of infection has 2 phases, the prodromal phase and the icteric phase.

Prodromal-phase symptoms include the following:

Myalgia
Arthralgia
Fever with mild temperature elevations (25-97%)
Anorexia (66-100%)
Nausea/vomiting (30-100%)
Weight loss (typically 2-4 kg)
Dehydration
Right upper quadrant pain that increases with physical activity (abdominal pain is reported in 35-80% of patients)

Icteric-phase symptoms include the following:

Jaundice – This may be difficult to see with some patients’ natural skin color; the serum bilirubin level is higher than 3 mg/dL; scleral icterus is present
Dark urine
Light-colored stools (20-40%)
Pruritus (50%)

Other features include the following:

Urticarial rash
Diarrhea
Malaise (95-100%)

When or how long the patient is infectious cannot be determined, but infectivity may relate to the presence of the virus in the stool.

Physical Examination

Physical examination should focus on the following:

Right upper quadrant tenderness
Possible enlarged liver (palpable edges; hepatomegaly is noted in 10-85% of patients)
Possible splenomegaly
Possible transient spider angiomata

Proceed to Differential Diagnoses

Contributor Information and Disclosures

Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Coauthor(s)

Jonathan M Schwartz, MD Associate Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Sciences University School of Medicine

Jonathan M Schwartz, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and American Hepato-Pancreato-Biliary Association

Disclosure: Nothing to disclose.

Kenneth Ingram, PAC Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University School of Medicine

Disclosure: Nothing to disclose.

Kenneth D Flora, MD Adjunct Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Oregon Health Sciences University School of Medicine; Consulting Staff, Department of Gastroenterology, The Oregon Clinic

Kenneth D Flora, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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