Hepatitis C Symptoms
Symptoms of hepatitis C virus (HCV) infection typically become more severe as the infection progresses. The most common symptoms of hepatitis C include:
Fatigue Fever Jaundice Nausea and vomiting Decreased appetite Abdominal pain Diarrhea Joint pain Muscle pain
Some of the symptoms of hepatitis C are similar to the symptoms of any liver disease.
Bleeding and bruising: The liver plays a role in producing proteins that aid in blood clotting, which is part of healing from an injury. Bleeding and bruising can be signs of liver dysfunction, resulting from the viral attack on the liver, as well as the body’s inflammatory response to the virus. Dark-colored urine: The build-up of bilirubin, which is produced when the liver is infected or impaired, can cause jaundice, as well as the dark coloring of the urine (choluria). Pale or chalky stools
Acute hepatitis C refers to the beginning stages of the condition. In acute hepatitis, these symptoms typically resolve on their own, although more severe cases involving jaundice and choluria may take up to a year. If acute hepatitis C progresses to long-term chronic hepatitis, these symptoms are generally more persistent.
If hepatitis C progresses to liver failure, symptoms may include generalized flu-like symptoms, as well as more specific signs of liver involvement because the virus targets the liver.
Rare Symptoms
A number of less common hepatitis C symptoms can occur during the acute or chronic stages. Many of these symptoms result from liver dysfunction or from the body’s inflammatory response to the virus.
Weight loss: This may occur due to a number of effects of HCV infection. Nausea, vomiting, and fatigue can diminish your appetite, causing you to reduce the amount of food you want to eat. And, as the liver becomes impaired, it may not produce several important proteins and fats that help you digest and absorb the food you eat, leading to diarrhea and basically, malnutrition even when you eat. Abnormal tingling or burning sensationsAn uncomfortable “pins and needles” sensationItchy skinRaised, bumpy areas of rashDry eyes accompanied by dry mouthRheumatic diseases: Joint swelling and muscle aches and pains can begin before you know that you have been exposed to HCV and may also occur at any stage of the infection. The joint and muscle pains are due to the fact that the immune system is stimulated continuously to fight the virus. Vasculitis (inflammation of the blood vessels) rarely occurs and may cause a range of effects, including pain, blood clots, and even strokes or heart attacks, although this is rare. Cryoglobulinemia: Cryoglobulins are proteins within the blood that get solidified when exposed to cold temperatures, causing problems with circulation.
Stages of Hepatitis C
The impact of HCV in the body changes over time after the initial infection. This is largely due to the proliferation of the virus, which can reproduce inside the body, making numerous copies of itself. The progression also has to do with the cumulative effect of the virus on the liver.
The stages of HCV infection include:
Incubation period: During this stage, you could have been infected with the virus, but you most likely will not have any hepatitis C symptoms. If you do have symptoms, they may include fever, fatigue, or stomach upset. Acute hepatitis: About two to 12 months after the virus invades the body, HCV can cause mild to moderate illness. Symptoms of acute infection are seen in about 15 to 20 percent of people who have been exposed to the virus. Presentation is often flu-like, with little evidence of liver injury. About one in four people successfully fight off the virus during this stage. Chronic hepatitis: The majority of those infected with HCV go on to have chronic hepatitis. Chronic infection occurs when the hepatitis C virus (HCV) does not spontaneously clear and remains in the body. Some people develop chronic hepatitis C symptoms years after being infected with the virus, without ever having had acute hepatitis C symptoms. End stage hepatitis: A more complicated form of the disease manifests with liver failure and a number of serious complications, which can include kidney failure and liver cancer.
Complications
The chronic stage of hepatitis C can persist for decades. During this time, steatosis (chronic build-up of fats) and fibrosis (progressive scarring of tissue) can cause damage to the liver. Both of the conditions often develop silently, with most people experiencing little or no signs of illness.
End-stage liver disease refers to the point where the liver has been severely damaged and is unable to function. Symptoms are usually highly evident at this stage, often affecting multiple organ systems, including the brain, kidney, and upper digestive tract.
Cirrhosis is staged by the degree of impairment and classified as either:
Compensated cirrhosisDecompensated cirrhosis
Compensated cirrhosis means that the liver is functioning relatively well and, as such, may cause minimal symptoms. When present, symptoms can include complications involving the skin, muscles, and joints as the constricted blood supply triggers both an increase in localized blood pressure, known as portal hypertension and a build-up of bile and other toxins.
Among the possible symptoms of compensated cirrhosis:
Spider veins, mainly on the trunk and face Itchy skin Redness on the palms of the hands Easy bruising or abnormal bleeding The build-up of fluid in the ankles and feet Poor concentration and memory Loss of appetite Weight loss Shrinking testicles Erectile dysfunction or loss of libido Alcohol intolerance
The end stage complications of hepatitis C infection include:
Decompensated cirrhosisHepatocellular carcinoma (HCC)End-stage renal disease (ESRD)
Decompensated cirrhosis is a serious condition in which the progressive scarring of the liver has left it severely damaged and unable to function. Symptoms are often profuse and progressive and can present in a number of ways, including:
Persistent fatigueJaundiceTarry or bloody stoolsThe build-up of fluid in the abdominal cavity, causing swelling and distentionA distinct “sweet-musty” to “rotten egg” breath odorExtreme bruising or bleedingAbnormally decreased urine outputPersonality changes, confusion, or tremorsIncreased sleepinessMuscle wastingWhite discoloration or “milk spots” on the nailsVomiting of bloodEsophageal varices (expanded blood vessels of the esophagus that may bleed)
Hepatocellular carcinoma (HCC) is a type of liver cancer that develops almost exclusively in association with cirrhosis in people with hepatitis C. The symptoms of HCC are similar to those of decompensated cirrhosis and can include:
Persistent fatigueJaundiceThe build-up of fluid in the abdominal cavityAbnormal bruising and bleedingUnintentional, extreme weight lossLoss of appetiteFeeling full after eating a small amountDelirium, confusion, or coarse “jerking” muscle movementsAbdominal discomfort, particularly in the upper right quadrant below or just under the ribs
End-stage renal disease (ESRD), which is advanced kidney failure, can both be caused and complicated by hepatitis C infection. The symptoms of ESRD vary and include:
Persistent fatigueChronic abdominal painAbnormally decreased urine outputInability to urinateUrine breath odorMottled or uneven, patchy skin discolorationMuscle wastingSwelling of the legs and feet, or around the eyesNausea or vomiting, particularly in the morning and after mealsIncreased sleepinessRepetitive twitchiness of the legsShortness of breath or difficulty breathingMental impairment, confusion
When to See the Healthcare Provider
Because hepatitis C symptoms may not occur in early stages, and because they are not always terribly alarming, even in the acute and chronic stages, you may need to see a healthcare provider even if you do not have obvious symptoms of the infection.
If you develop symptoms of liver failure or severe infection, you should also see your healthcare provider, as the cause could be HCV or another serious condition that also requires medical attention. Signs and symptoms to look out for include:
Having unprotected sex with someone who has or who could have HCVSharing needles with anyoneHaving had a cut or a break in your skin from a needle, glass, or any other object that was or could have been contaminated with HCV infected blood
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Persistent feversJaundiceChange in the color of your urineNausea, vomiting or diarrhea that is excessive or lasting for longer than a week Unexplained fatigue lasting longer than a weekSwelling of your abdomen
