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Physical Symptoms
  • mild to severe lethargy
  • loss of appetite
  • nausea and vomiting
  • soreness in the upper right part of the abdomen (under the ribs)
  • fever
  • pain in the joints
  • yellowed skin and eyes
  • dark-colored urine

Psychological Symptoms

  • inability to focus or concentrate
  • mood-swings
  • anger
  • depression

Clinical features:

About one-third of the cases follow acute hepatitis, but most develop insidiously de novo. Nonspecific malaise, anorexia, and fatigue often dominate the clinical picture, sometimes with low-grade fever and nondescript upper abdominal discomfort. Jaundice is variable and is not always present. Signs of chronic liver disease (eg, splenomegaly, spider nevi, and fluid retention) usually eventually develop. Multisystemic or "immune" manifestations often occur, especially in young women whose disease is of idiopathic origin. These can affect virtually any body system and include acne, amenorrhea, arthralgia, ulcerative colitis, pulmonary fibrosis, thyroiditis, nephritis, and hemolytic anemia. A minority of patients develop predominant cholestatic features suggesting primarily biliary cirrhosis.

Laboratory abnormalities include those of active hepatocellular inflammation, with predominant aminotransferase elevations and variable bilirubin and alkaline phosphatase values. ALT and AST levels are typically in the 100- to 500-IU-L range, though values can exceed 1000 IU-L and create confusion with acute hepatitis; in such cases other laboratory clues to chronicity may aid the diagnosis (eg, low serum albumin). Cholestatic laboratory features occasionally dominate. Serologic immune markers are common in idiopathic chronic active hepatitis (eg, striking IgG elevations, antinuclear Ab, smooth-muscle [anti-actin] Ab, LE cells, RF); these markers are usually absent in chronic active hepatitis due to viruses or drugs.

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