Jaundice was just a symptom. 45-year-old Delhi man’s cautionary tale

Hepatitis, in most cases, follows a fairly predictable course: fatigue, loss of appetite, mild jaundice, and then gradual recovery over a few weeks. But sometimes the liver stops coping the way it should, and what begins as a routine infection can rapidly progress to cirrhosis, acute-on-chronic liver failure (ACLF), or even hepatocellular carcinoma (HCC). This transition doesn’t always announce itself dramatically. It may unfold over days, and recognising the warning signs early can mean the difference between recovery and a life-threatening emergency.

Equally important is knowing who is at risk, understanding how hepatitis B and C spread, recognising high-risk behaviours, and identifying the symptoms that warrant immediate medical attention. “Prevention, early diagnosis, timely treatment and vaccination can prevent complications and allow people to lead long, healthy lives,” says Dr Choudhury. Excerpts:

Who is at risk of Hepatitis B or C? Who needs vaccination?

In India, hepatitis B is commonly acquired at birth from an infected mother. A family history of hepatitis, liver disease or liver cancer — particularly on the maternal side — also increases the risk. Other important risk factors include unprotected sex, multiple sexual partners, intravenous drug use, tattooing with unsterile equipment, unsafe injections and surgeries or blood transfusions involving infected blood.

Anyone with these risk factors should consider getting tested. Even if the test is negative, vaccination against hepatitis B can provide lifelong protection. Every pregnant woman should be screened for hepatitis B, and every newborn should receive the hepatitis B vaccine at birth, one of the most effective measures to prevent chronic liver disease later in life.

The jaundice that doesn’t behave

A slight yellowing of the eyes is something doctors commonly expect in hepatitis. When it is accompanied by dark, mustard oil-coloured urine, loss of appetite and fatigue, it usually reflects liver inflammation. This should never be ignored and warrants prompt medical evaluation. Self-medication, including over-the-counter drugs or herbal remedies, should be avoided until the cause is identified.

However, when jaundice continues to worsen, is accompanied by severe itching, or is associated with pale or clay-coloured stools, it may indicate more significant liver dysfunction or blockage of bile flow. These are warning signs that require urgent medical assessment.

When the mind starts acting strange

This is often the first change families notice, even before they realise what it means. Someone who was speaking normally the previous evening suddenly appears unusually sleepy, confused, forgetful, or begins saying things that make little sense. Some patients develop a characteristic flapping movement of the hands when they stretch out their arms and spread their fingers — a sign doctors call asterixis.

This condition, known as hepatic encephalopathy, develops because a failing liver can no longer remove toxins effectively from the bloodstream. If not treated promptly, it can progress rapidly to unconsciousness and coma. It should never be dismissed as fatigue, stress, or old age.

Bleeding that shouldn’t be ignored

Vomiting blood or passing black, tarry stools are medical emergencies. In patients with hepatitis, these symptoms often indicate bleeding from enlarged veins in the food pipe or stomach due to advanced liver disease. At the same time, unexplained bruising, persistent bleeding from the gums, or prolonged bleeding after minor injuries may reflect the liver’s inability to produce enough clotting factors. These symptoms demand immediate hospital care.

Why timing matters more than people realise

The most deceptive aspect of hepatitis is how quickly it can change. A patient who seems to be recovering may deteriorate within a day or two. There is no universal timeline, making it essential to seek medical attention immediately if jaundice worsens, confusion develops, bleeding occurs or swelling of the abdomen appears. Waiting for symptoms to settle on their own can cost valuable time.

The takeaway

Jaundice is never the disease — it is the body’s alarm bell. Most people with hepatitis recover completely with appropriate care, but a small proportion develop life-threatening complications because the warning signs are missed or ignored. Recognising these red flags, identifying those at risk, getting vaccinated where appropriate, and seeking timely medical attention remain the most effective ways to prevent a manageable illness from becoming a medical emergency.