A number of clinical syndromes may develop after exposure to hepatitis viruses

• Carrier state: without clinically apparent disease or with chronic hepatitis. A carrier state is best characterized for HBV. Individuals with impaired immunity are particularly likely to become carriers.

• Asymptomatic infections: Serologic evidence (on basis of minimal elevation in serum transaminases)

• Acute viral hepatitis: pre-icteric or icteric

Pre-icteric phase: marked by non-specific constitutional symptoms like malaise, nausea, fatigue, loss of appetite, low grade fever, muscle and joint pains. Physical examination reveals mildly enlarged tender liver.

Icteric Phase: With appearance of jaundice patient enters into icteric phase. The jaundice is caused predominately by conjugated hyperbilirubinemia and hence accompanied by dark colored urine.

• Chronic hepatitis: Without or with progression to cirrhosis. It is defined as symptomatic, biochemical, or serological evidence of continuing or relapsing hepatic disease for more than 6 months, with histologically documented inflammation and necrosis. Most common symptoms involve fatigue, loss of appetite, and occasional bout of mild jaundice. Physical finding are few, the most commonly being Spider angiomas, Palmar erythema, Mild hepatomegaly, Hepatic tenderness.

• Fulmitant hepatitis: It is the cause of 50-65% of fulmitant hepatic failure. It can be induced by hepatitis viruses A, B, C, D (either coinfection or super-infection with B virus) and E.