Symptoms and Diagnosis




What are the symptoms of chronic hepatitis B?
  • Feeling easily tired is often time the first symptom of liver disease
  • Pain or discomfort over the liver, poor appetite and nausea can also occur
  • Often there are no symptoms until late stages of liver disease
  • Even people with a completely scarred liver (cirrhosis) or those with liver cancer may not have symptoms
  • The warning signs of cirrhosis and a poorly functioning liver include:
    • yellow eyes and/skin
    • swollen feet (edema)
    • swollen abdomen (ascites)
    • muscle loss
    • vomiting blood and/passing blood (dark red or black stools)
    • difficulty sleeping during the night and increased sleeping during the day
    • confusion (encephalopathy)
How is hepatitis B diagnosed?
  • Hepatitis B is easily diagnosed through blood tests
    • Note: these tests are not part of regular check-ups
    • Many people are not tested routinely
  • People sometimes learn they have hepatitis B when they donate blood, since donated blood is routinely checked for viruses such as hepatitis B
  • The blood tests for hepatitis B indicate whether there is active infection, or whether there is immunity
  • The interpretation of these tests is complex and requires consultation with a doctor
Who should get tested for hepatitis B?
  • Those with risk factors for hepatitis B (see "Who is at Risk" above)
  • People whose parents were born in countries where hepatitis B is common (see map)
Why are ALT and AST useful?
  • ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes that are found in the blood and are elevated when the liver is being damaged, such as in hepatitis B
  • ALT and AST are tested regularly to:
    • monitor how active the hepatitis is
    • to assess if treatment should be started
    • to see if the treatment is working
  • A single normal ALT and AST test does not mean there is no damage in the liver
  • They have to be done regularly to assess what the virus may be doing to the liver
Why is a liver biopsy useful?
  • It is used to determine:
    • How much damage is being done by hepatitis B
    • Whether treatment should be started
  • The procedure:
    • It is usually performed as an outpatient procedure
    • The most common type of biopsy is with a needle that is passed through the skin (percutaneous needle biopsy)
    • Ultrasound examination is often performed before the biopsy to pinpoint the safest location for the needle to be placed
    • The area around where the needle will be inserted is numbed with a local anesthetic
    • The biopsy itself is done very quickly the needle is passed into and out of the liver in less than a second