Pediatric Hepatitis A Clinical Presentation

Updated: Apr 14, 2016
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Presentation

History and Physical Examination

History

The incubation period from the time of exposure to hepatitis A virus (HAV) to the appearance of symptoms is around 28 days (range 2 wk to 6 mo). The patient’s initial symptoms during the prodromal period include low-grade fever, nausea, vomiting, decreased appetite, and abdominal pain. Older children and adults are more likely to report pain in the right upper quadrant.

Diarrhea may occur in young children, whereas constipation is more common in adults. If present, jaundice, dark urine, and light-colored stool develop several days to a week after the onset of systemic symptoms. Anicteric infections are common in young children.

Physical examination

The general appearance is that of mild-to-moderate illness. A patient who appears severely ill is likely to have hepatitis of another cause or an atypical course. Mild hepatomegaly and right upper quadrant tenderness may be present. Clinical jaundice is present in two thirds of symptomatic patients. Splenomegaly may occur in 10-20% of patients.

Complications

Complications are few. Fulminant hepatitis with massive hepatic necrosis and liver failure due to HAV infection is rare. Cholestatic hepatitis occurs in a small percentage of patients. It is identified by persistent hyperbilirubinemia, pruritus, and constitutional symptoms that last for 12-16 weeks in the absence of biliary obstruction on sonograms.