Nhiều bệnh nhân không bị vàng da lâm sàng, và sẽ phục hồi dần dần sau đó từ 3 đến 4 tháng. Hiếm khi, suy gan kịch phát phát triển với một hình ảnh lâm sàng của bệnh não, rối loạn đông máu, và nhanh chóng xấu đi vàng da. | 164 SECTION 8 GASTROINTESTINAL EMERGENCIES Many patients do not become clinically jaundiced and most will recover gradually over the ensuing 3 to 4 months. Rarely fulminant hepatic failure develops with a clinical picture of encephalopathy coagulopathy and rapidly worsening jaundice. Chronic persistent infection usually with hepatitis B or C can lead to the development of cirrhosis with gradual jaundice ascites peripheral edema and liver failure over a period of 10 to 20 years. Hepatitis A virus HAV is transmitted predominantly by the fecal-oral route and is commonly seen in Americans. Children and adolescents are more commonly affected but often subclinically whereas most adults are symptomatic with a longer more severe course. Symptom onset is often more abrupt than with other viruses. Epidemic outbreaks have been seen in children at day care centers institutionalized patients and patients exposed to a common-source case via contaminated food or water. Hepatitis B virus HBV is acquired primarily via a percutaneous exposure to infected blood or body fluids. Most cases are subclinical without jaundice. Often symptom onset is insidious and in 5 to 10 percent of cases is preceded by a serum sicknesslike syndrome with polyarthritis proteinuria and angioneurotic edema. Symptomatic patients usually have a more severe and protracted course than those with HAV. Chronic HBV infection occurs in 6 to 10 percent of patients who may go on to develop cirrhosis end-stage liver disease ESLD and hepatocellular carcinoma. HCV is the most common of all blood-borne infections in the United States and may be contracted via parenteral sexual or perinatal contact. Most patients remain asymptomatic or have milder symptoms than those with HBV or HAV. Unfortunately chronic HCV infection occurs in 85 percent of patients the majority of whom remain subclinically infected. Up to 70 percent of chronic HCV cases progress to the development of chronic liver disease cirrhosis and ESLD and are at
