Hepatitis A and Jaundice: Symptoms, Treatment and Prevention

Every year, once the rains come and the water gets contaminated, clinics in Pakistan fill up with people whose eyes and urine have turned yellow. In most cases the cause is hepatitis A, a liver infection that spreads through dirty food and water. The good news is that it usually clears on its own and, unlike hepatitis B and C, it does not become a long-term infection. The bad news is that you can feel quite miserable for weeks, and a few people, especially older adults, get seriously ill.

What is hepatitis A and what is jaundice?

Hepatitis A is inflammation of the liver caused by the hepatitis A virus. Jaundice is not a disease in itself. It is the yellow colour of the skin and the whites of the eyes that appears when bilirubin, a pigment normally cleared by the liver, builds up in the blood. Hepatitis A is the most common cause of jaundice in children and young adults in Pakistan, but jaundice can also come from hepatitis B, hepatitis C, gallstones, alcohol, medicines and other liver problems.

How does it spread?

• Drinking unboiled or contaminated water, and ice made from it
• Street food, salads, fruit and juices handled by someone who is infected and did not wash their hands
• Close contact with an infected person at home, especially when toilets are shared
• Raw or undercooked shellfish from polluted water

Symptoms

Symptoms appear two to six weeks after infection. Small children often have no symptoms at all, while adults are more likely to be unwell.

• Tiredness and weakness that feels out of proportion
• Loss of appetite, nausea and vomiting
• Fever and body aches
• Pain or discomfort in the upper right side of the abdomen
• Dark, tea-coloured urine
• Pale or clay-coloured stools
• Yellow eyes and skin, and itching

How is it diagnosed?

Your doctor will examine you and order blood tests. A liver function test (LFT) shows raised bilirubin and liver enzymes such as ALT, and a specific blood test for hepatitis A antibodies (anti-HAV IgM) confirms the diagnosis. Tests for hepatitis B and C are often done at the same time so that other causes are not missed.

Treatment

There is no specific antiviral medicine for hepatitis A. Treatment is about supporting the body while the liver heals, which usually takes a few weeks.

• Rest: do not push yourself back to work or school too early.
• Fluids: drink plenty of boiled or filtered water. Vomiting and poor appetite can quickly cause dehydration, and oral rehydration salts help.
• Small, frequent meals: eat whatever you can tolerate. Plain home-cooked food such as khichdi, daal, rice, boiled vegetables and fruit is easier than oily or spicy food. The old advice to avoid all fat or protein is not necessary, but heavy, greasy meals often make nausea worse.
• No alcohol at all until your doctor says the liver has recovered.
• Be careful with medicines. The liver processes most of them. Do not take painkillers, herbal remedies, “liver tonics” or antibiotics on your own. Even paracetamol should be used only as your doctor advises. Anti-sickness medicines are prescribed for severe nausea.

Home remedies: what is safe and what is not

Many families take the patient to a spiritual healer or give herbal drinks, sugarcane juice, or use “jaundice” threads and charms. Fresh boiled-water-based drinks and sugarcane juice made hygienically are generally fine for fluids and energy, but many herbal and unlabelled products have been linked with liver damage. Please do not delay seeing a doctor and do not start herbal “cures” without asking.

Preventing hepatitis A

• Vaccination: the hepatitis A vaccine is safe and gives long protection. It is recommended for children and for adults who have not had the infection, especially before travel or if you work in food service or healthcare. Ask your doctor.
• Drink boiled, filtered or bottled water from a trusted source.
• Wash hands with soap after using the toilet, changing nappies and before preparing or eating food.
• Wash fruit and vegetables well and avoid salads and cut fruit from doubtful sources.
• Keep the patient’s plates, cups and towels separate, and clean the toilet regularly.
• Family members and close contacts should speak to a doctor about vaccination.

When to see a doctor, or go to hospital

• Yellow eyes or skin, or dark urine with pale stools, even if you feel fairly well
• Constant vomiting and you cannot keep fluids down
• Severe weakness, confusion, extreme sleepiness, or a change in behaviour
• Bleeding, black stools, or swelling of the abdomen
• Jaundice in a newborn, a pregnant woman, an older adult, or someone with existing liver disease
• Jaundice lasting more than two to three weeks, or getting worse

Key takeaways

• Hepatitis A spreads through dirty water and food, and is common in Pakistan after rains.
• It usually heals completely with rest and fluids, but see a doctor to confirm the cause of jaundice.
• Avoid alcohol and do not take medicines or herbal remedies without medical advice.
• Clean water, hand washing and the hepatitis A vaccine protect you and your family.

Related products on Medimart

• Oral rehydration salts (ORS): replace fluids and salts lost with vomiting and poor intake
• Ondansetron: a prescription anti-sickness medicine for severe nausea
• Hepatitis B vaccine: protects against another common cause of jaundice

You can also browse liver care products on Medimart, with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription and should be taken only as advised by your doctor.

This guide is for general information and does not replace advice from a doctor.