Complications of hepatitis A can include the infection returning (relapse), cholestasis, or, in rare cases, liver failure.

Relapse

Around 15% of people with hepatitis A experience a relapse, where the infection returns with the same symptoms. 

A relapse usually occurs around one to four months after the original illness, and this can happen more than once.

Cholestasis

A complication that can affect older adults with hepatitis A is bile building up inside the liver. Bile is a substance used to help digest fats and is normally moved out of the liver into the gallbladder. The medical term for this build-up is cholestasis.

Symptoms of cholestasis include:

• persistent jaundice (yellowing of the skin and eyes) that can often last longer than three months
• a high temperature (fever) of or above 38ºC (100.4ºF)
• diarrhoea
• weight loss

Cholestasis will normally resolve by itself without the need for treatment.

Liver failure

A rare and potentially fatal complication of hepatitis A is that the infection stops the liver working properly. This is known as liver failure.

This complication usually occurs in those:

• with a pre-existing liver disease, such as cirrhosis (scarring of the liver) or hepatitis C (a more serious type of liver infection)
• with a weakened immune system (which could be the result of a condition such as diabetes, or as a side effect of a treatment such as chemotherapy)

Some symptoms of liver failure are similar to hepatitis A and include jaundice, nausea and vomiting.

Other symptoms of liver failure include:

• a tendency to bruise and bleed easily (for example, frequent nosebleeds or bleeding gums)
• hair loss 
• fever and shivering attacks because you're more prone to infections
• oedema – a build-up of fluid in the legs, ankles and feet
• ascites – a build-up of fluid in the abdomen, which can make you look heavily pregnant
• drowsiness and confusion

It is often possible to compensate for the loss of normal liver function using medication, but a liver transplant is necessary to achieve a complete cure.