Symptoms of HCV
Hepatitis C is the most common liver disease currently seen in clinical practice. The incubation period, from the time of exposure to the virus until the onset of the disease, is one to six months. Early symptoms include poor appetite, lack of interest in food, nausea, aching muscles and joints, and light fever. Some people experience only mild symptoms such as tiredness, periodical pressure below the right ribs caused by the enlarging liver, and aching muscles and joints. Only 1 in 10 patients with acute Hepatitis has symptoms. The remaining nine have no symptoms whatsoever. In 8 out of 10 patients, the infection becomes chronic.
Symptoms of Acute Viral Hepatitis
General Symptoms. Symptoms of acute viral hepatitis may begin suddenly or develop gradually. They may be so mild that patients mistake the disease for the flu. Nearly all patients experience some fatigue and often have mild fever. Gastrointestinal problems are very common, including nausea and vomiting and a general feeling of discomfort in the abdomen or a sharper pain that may occur in the upper right area if the abdomen. This pain tends to increase during jerking movements, such as climbing stairs or riding on a bumpy road. GI problems can lead to loss of appetite, weight loss, and dehydration. After about two weeks, dark urine and jaundicea yellowish color in the skin and whites of the eyes -- develops in some, but not all, patients. Children tend not to develop jaundice. About half of all hepatitis patients have light colored stools, muscle pain, drowsiness, irritability, and itching -- usually mild. Diarrhea and joint aches occur in about a quarter of patients. The liver may be tender and enlarged and most people have mild anemia. In about 10% of patients, the spleen is enlarged.
Symptoms of Fulminant Hepatitis. In very rare cases, within two months of onset, a very serious condition known as fulminant hepatitis develops. Symptoms may include a large swollen abdomen (known as ascites) and a peculiar hand-flapping tremor (called asterixis). These symptoms may be followed by stomach and intestinal bleeding and mental confusion, stupor, or coma caused by brain injury (encephalopathy).
Symptoms Typical of Acute Hepatitis A. Symptoms of hepatitis A are usually mild, especially in children. They generally appear between two and six weeks after exposure to the virus. Adult patients are more likely to have fever, jaundice, and itching that can last one to several months.
Symptoms Typical of Acute Hepatitis B. Hepatitis B symptoms appear long after the initial infectionusually four to 24 weeks. Many patients may not even experience symptoms, or they may be mild and flu-like. About 10% to 20% of patients have a fever and rash. Nausea is not common. Hepatitis B patients may experience general aching in the joints, but sometimes the pain can resemble arthritis, affecting specific joints and accompanied by redness and swelling.
Symptoms Typical of Acute Hepatitis C. If they appear at all, symptoms develop about a month or two after a person is infected with hepatitis C. These are usually milder than those of hepatitis B. About 75% of patients show no signs of jaundice, and many do not experience any symptoms.
Symptoms of Chronic Hepatitis
Symptoms of Chronic Hepatitis B and C. Both hepatitis B and C can progress to chronic hepatitis usually with no early acute symptoms. Symptoms of progressive chronic viral hepatitis may be very subtle and no more than a mild persistence of acute symptoms for six or more months. In fact, chronic hepatitis C can be present for as long as 20 years without presenting any obvious problems. In some patients, itchy skin may be the first symptom. Some patients develop pain in small joints in the body (such as the hand) that may be nearly indistinguishable from symptoms of rheumatoid arthritis, fibromyalgia, or carpal tunnel syndrome. In other patients, chronic hepatitis B or C can lead to long term disability or liver failure before they experience any symptoms at all.
SIGNS AND SYMPTOMS THAT MAY BE ASSOCIATED WITH HEPATITIS C
Many patients remain asymptomatic until decompensation occurs. Lack of symptoms and minor liver enzyme elevations are typical of HCV infection and cannot be taken as evidence of lack of progression. HCV RNA testing confirms the diagnosis. Liver biopsy helps assess disease activity and stage the severity of fibrosis and is recommended for most patients with hepatitis C. Once this information is obtained, a rational program for treatment and monitoring can be planned. Patients with newly discovered hepatitis C infection require thorough education about the disease's natural history, transmission, interaction with alcohol, and treatment. In many cases, referral to a gastroenterologist or hepatologist may be the appropriate way to ensure necessary instruction and availability of the latest treatment options.
(Tina M. St. John, MD )
INTRODUCTION:
Hepatitis C affects different people in different ways. Your personal experience with hepatitis C will be as unique as you are. This chapter reviews the most common signs and symptoms experienced by people with chronic hepatitis C. At first glance, the mere length of the chapter may appear overwhelming, but keep in mind, this is just a list of possibilities. If you have any of the signs or symptoms described in this chapter, it is important that you do not assume they are a result of having hepatitis C. Your health care provider can determine if they are associated with your hepatitis C. Very few people experience all of these signs and symptoms. Many of them will come and go on their own. For troublesome and/or persistent problems, there are things you and your health care provider can do to either make them go away, or make them easier to live with.
You may be wondering what the difference is between a sign and a symptom. A sign is an abnormality that is detected by your health care provider during an examination. A symptom is something you, as a person with hepatitis C, experience as a result of the disease. Signs and symptoms are discussed together because sometimes a sign is also a symptom. Fever is a good example of something that is both a sign and a symptom. Your health care provider can take your temperature and find out that you have a fever, so it is a sign. But if you have a fever, you can tell you have a fever because your skin is warm, so fever is also a symptom.
There are three sections following this introduction.
The first section briefly explains how the hepatitis C virus causes disease. The second section reviews possible signs and symptoms that people with hepatitis C who do not have cirrhosis may experience. The last section reviews additional signs and symptoms that people with hepatitis C who have cirrhosis may experience.
HOW THE HEPATITIS C VIRUS CAUSES DISEASE:
According to current understanding, the hepatitis C virus (HCV) causes disease in two general ways. The first is by infecting cells. Once inside the cell, the virus directly damages or kills the cell. This mechanism is called cytopathic damage. The second way the hepatitis C virus causes damage is by provoking an immune response. The immune system is your body's way of protecting itself from invading agents such as viruses and bacteria. An overactive or misdirected immune response can damage infected cells and the normal surrounding tissue. This mechanism is called immunopathic damage. When HCV was first discovered, experts thought the virus infected only liver cells. However, more recent research has revealed that HCV also infects parts of the immune system, specifically the lymphatic system and peripheral blood mononuclear cells.
Experts now understand that hepatitis C is not just a liver disease but is a systemic disease, meaning it can affect nearly any organ of the body. As you read through the list of possible signs and symptoms associated with hepatitis C infection, you may find some of the symptoms you have been experiencing that you thought were caused by something else may actually be caused by hepatitis C. This is important because knowing why you are having a symptom is often the first step in alleviating the symptom, or making it less troublesome.
SIGNS AND SYMPTOMS OF HEPATITIS C WITHOUT CIRRHOSIS:
The possible signs and symptoms of hepatitis C without cirrhosis involve every organ system of the body. Although some of these symptoms can be quite uncomfortable, most of them do not indicate that your liver disease is getting worse. New symptoms should always be discussed with your health care provider so you can work together to keep your life with hepatitis C as active, productive, and enjoyable as possible.
Arthralgia:
Arthralgia is pain in the joints. Frequent sites of joint pain are the hips, knees, fingers, and spine, although any joint can be a source of pain. Arthralgia associated with hepatitis C can be migratory, meaning it moves around. You may have pain in your hip one day and in your knee the next. This symptom usually comes and goes, and is rarely present all the time. If you experience joint pain, it is important to talk with your health care provider before taking anything to treat the pain because some over-the-counter pain medicines (such as acetaminophen) are potentially harmful to the liver.
Fever, Chills, and Night Sweats:
Many people with HCV periodically experience fevers. The fevers are usually low, typically less than 101 degrees Fahrenheit. As the fever comes down, you may experience chills and sweating. You may have fevers only at night. If this happens, you may wake up with your bedclothes and/or your sheets wet with sweat. This experience is called night sweats.
Fatigue:
Fatigue is feeling tired, and nearly all people with hepatitis C experience fatigue at one time or another. The fatigue may be mild and relieved by naps or going to bed earlier. However, the fatigue can be severe at times, feeling like near exhaustion even after a full night of sleep. Fatigue experienced by people with hepatitis C may also be accompanied by increased feelings of anger, hostility, and depression.1 These feelings may persist even after the fatigue has passed.
Fluid Retention:
Fluid retention occurs when your body holds on to more water than it needs. The extra water leaks into the tissues. If you have fluid retention, you may notice swelling of your feet, ankles, fingers, and/or face. People with fluid retention often have frequent urination, especially at night.
Flu-like Syndrome:
People with hepatitis C can experience periodic flu-like syndromes. These episodes usually last a few days, rarely more than a week. The most common symptoms are fever, chills, headache, fatigue, and muscle aches.
Lymphadenopathy:
Lymphadenopathy is swelling of the lymph nodes. Lymph nodes are normally about the size of a pea or a kidney bean. Because HCV infects the lymphatic system, it frequently causes the lymph nodes to swell. The lymph nodes of the armpits, groin, and neck are relatively close to the skin surface, and are usually examined to see if you have lymphadenopathy. If you have lymphadenopathy, it may or may not be painful when you press on the swollen lymph nodes.
Myalgia: Myalgia is muscle pain or aching.
People with hepatitis C may experience myalgia. Usually, if you have this symptom, you will experience it as a generalized feeling. However, some people report having pain in only one area of the body. This symptom tends to come and go, and is rarely present all the time. If you experience muscle aches or pain, it is important to talk with your health care provider before taking anything to treat the pain because some over-the-counter pain medicines are potentially harmful to the liver.
Pruritus:
Pruritus is the medical word for itching. People with hepatitis C sometimes have pruritus. Often, it is limited to the palms of the hands and/or the soles of the feet. However, some people have generalized pruritus, meaning they itch all over.
Sleep Disturbances:
Insomnia is difficulty sleeping, and it may be part of your experience with hepatitis C. Insomnia can occur in different forms. You may have trouble falling asleep, or you may wake up often during the night. Some people report having unusually vivid, intense, and/or frightening dreams. Such dreams can contribute to insomnia. Spider Nevi: Spider nevi are small, red, spider shaped spots on the skin. They are usually less than ½ inch around. They are most commonly seen on the face and chest, but can occur anywhere on the skin. Spider nevi are painless and do not itch. Weakness: People with hepatitis C sometimes experience a sense of weakness. This symptom can vary from mild to severe, and tends to come and go.
Abdominal and Digestive System
Signs and Symptoms Abdominal Pain:
You may experience episodes of abdominal pain if you have hepatitis C. Pain on the right side just below the ribs is likely to be from the liver. People usually report this pain as being short, sharp, or stabbing. More constant, cramping pain closer to the middle of chest, but under the ribs, can be due to gall bladder problems that may accompany hepatitis C. You may experience pain elsewhere in the abdomen. If you experience any new pain in the abdomen, it is important for you to tell your health care provider right away so the source of the pain can be determined.
Pain and Liver Disease
In many patients that have been diagnosed with hepatitis and/or
liver disease, many complain of abdominal pain, located mostly in
the right upper quadrant, right flank or epigastric area. Although
less frequent, left upper quadrant and lower abdominal pain has
also been reported.
Abdominal pain:
The nervous system pathways that convey abdominal pain messages are
known as the visceral and somatic pathways. Both of these pathways
are part of the sympathetic nervous system. The visceral fibers are
sensitive to stretch and spasm but are not affected by temperature
or sectioning of the nerve. The somatic pathways innervate the
abdominal cavity wall, parietal peritoneum, and parts of the
diaphragm. These fibers are sensitive to pressure, tension,
traction, chemical and bacterial toxins, enzymes, infiltrative
processes and edema. The central parts of the diaphragm and biliary
tract have axon fibers that carry messages in conjunction with the
phrenic nerve and are responsible for complaints of referred pain
to the shoulder area.
Biliary system pain:
Gallbladder and biliary tract spasms can cause pain that radiates
to the right shoulder and subscapular area. Inflammation of the
gallbladder wall can cause localized subcostal pain and rebound
tenderness.
Intestinal pain:
Most acute or chronic abdominal pain is bowel related. Right upper
quadrant pain is frequently due to large bowel distention (hepatic
flexure area) and small bowel ileus producing spasms and/or cramps.
Pain in the left upper quadrant can also be caused by distention of
the colon in the splenic flexure area. Lower abdominal pain would
be more likely caused by bladder or rectal problems.
Liver pain:
Liver pain (right upper quadrant) is due to the distention of the
liver capsule which has pain receptors. Rapid increases in liver
size from inflammation (viral hepatitis or alcohol induced) or a
tumor are the most common causes of liver pain. When the liver
becomes cirrhotic, specific liver pain is rarely the cause of right
upper quadrant complaints.
Pancreatic pain:
In viral or alcohol induced liver disease, the pancreas may become
inflamed, stimulating somatic nerve endings, causing severe pain
that radiates to lateral quadrants, back and left shoulder, going
through the back. It is made worse by lying down and improved when
in the knee chest position or bending forward.
Splenic pain:
Splenomegaly or infarction of the spleen may be present with liver
disease. Pain complaints will be most likely right upper quadrant.
Pain in acute or chronic liver disease may be difficult to manage
due to the excretion of many analgesics by the liver and/or
kidneys. Reduced dosages, and careful monitoring of hematological
and neurological function is critical to prevent accumulation and
toxicity. Acute or chronic hepatic failure may lower plasma
clearance of opiates such as Morphine, prolong the terminal
elimination half-life, and increase oral bioavailability
(Hasselstrom, Eriksson, Persson, Rane, Svensson, and Sawa, 1990).
Non- opiate analgesics are often contraindicated in patients with
hepatic or renal dysfunction. Acute pain in the face of chronic
disease needs prompt investigation, to rule out ulcer,
gastrointestinal bleeding, thrombosis of the portal system or
spleen, presence of tumor or development of inflammation or
infection.
Appetite Changes and Weight Loss:
People with hepatitis C frequently experience changes in their appetites. You may find you no longer want the foods you once enjoyed. Many people find they are particularly put off by fatty foods and alcohol. For some, foods that are at room temperature or cold are more appealing than hot foods. The distaste for alcohol is actually good for you because alcohol increases the damage done to the liver by HCV. People with hepatitis C should not drink any alcohol including beer, wine, wine coolers, and mixed drinks. If changes in your appetite are causing you to lose weight, you need to discuss this with your health care provider because good nutrition is particularly important for people with hepatitis C.
Bloating:
Bloating is usually described by people with hepatitis C as a feeling of fullness in the abdomen. You may notice your clothes seem tight around your waist. This bloating may or may not be accompanied by weight gain.
Diarrhea and Irritable Bowel Syndrome:
Diarrhea can be experienced as unusually loose stools or an increase in the frequency of bowel movements, with or without a change in the consistency of the stool. If the diarrhea is accompanied by cramping abdominal pain and persists, it is often termed irritable bowel syndrome.
Indigestion and Heartburn:
Indigestion is usually experienced as an uncomfortable feeling of fullness in the stomach. It is often accompanied by queasiness and burping of a mixture of gas and stomach contents. When this occurs, you may notice a burning in your throat and/or a sour taste in your mouth. Heartburn is experienced as pain or burning in the chest under the breastbone. It, too, may be accompanied by burping of gas and stomach contents. Both indigestion and heartburn can be brought on by and last longer after a fatty meal.
Jaundice:
Jaundice is a yellowish discoloration of the skin and/or the whites of the eyes. It is caused by a yellow substance in the blood called bilirubin. The liver normally breaks down bilirubin. If the liver is not working normally, bilirubin can build up in the blood and begin to stain the skin. If the liver starts to work more normally, jaundice will fade or go away.
Nausea:
Nausea is the feeling that you may vomit. Hepatitis C may cause episodes of nausea. Although it is usually not accompanied by vomiting, it can be a very uncomfortable and debilitating symptom. If you are having nausea, talk with your health care provider because there are many ways to treat this symptom.
Cognitive, Mood, and Nervous System Signs and Symptoms
Cognitive Changes: Your cognitive ability refers to your ability to think clearly and to concentrate. Some people with hepatitis C notice they have changes in their cognitive ability. This can take several different forms. You may find you cannot concentrate for long periods of time, or you may notice your thought processes seem slower than usual. You may have a hard time coming up with words you want to say, or you may just feel mentally tired. These cognitive changes are sometimes called ‘brain fog.’ Like other symptoms of hepatitis C, these cognitive changes often come and go.
Depression:
Hepatitis C does not directly cause depression, but concerns about the disease and changes it may cause in your life can lead to depression. Some of the symptoms of depression include: • sleeping more or less than usual
• eating more or less than usual
• hopelessness
• helplessness
• irritability
• lack of interest in your usual activities, and
• feelings of sadness and/or despair most of the time
If you have one or more of these symptoms, you may have depression and should discuss what you are feeling with you health care provider.Depression can seriously interfere with your quality of life, and can make it difficult for you to do what you need to do to take care of yourself. Depression is nothing to be ashamed of, and it can be treated. If you have any of the symptoms of depression, talk to your health care provider right away.
Dizziness:
Some people experience dizziness as feeling as if they are going to faint. Others experience dizziness as disorientation, or feeling as if the world is spinning around them. Both of these can be symptoms of hepatitis C. If you are experiencing dizziness, talk with your health care provider because this can be not only troublesome for you, but also dangerous.
Headaches:
Headaches can be symptoms of hepatitis C. For some people, the headaches are mild, but for others, the headaches are severe. If you are having headaches, talk to your health care provider before taking any medicines for your headaches because some over-the-counter pain medicines can be harmful to your liver.
Mood Swings:
Hepatitis C can sometimes cause mood swings. Some people find this symptom is worse during the winter months.
Numbness or Tingling:
A significant number of people with hepatitis C have numbness or tingling in their extremities. Your extremities are those parts of your body that extend from the main part of your body, that is, your arms and legs, fingers and toes. Most people with numbness or tingling feel it in their fingers and toes, but it may extend into the arms and legs. Numbness is a decreased sense of feeling. In its most severe form, the affected areas have no sense of feeling. Tingling can sometimes be painful. People describe painful tingling as feeling like being stuck with pins. This symptom tends to come and go.
Visual Changes:
There are a number of visual changes that can accompany hepatitis C infection. You may find you are not seeing as clearly as you once did. Peripheral vision, that is, the ability to see things that are at the sides of your view, can also be diminished. Some people report seeing small specks called ‘floaters’ moving across their view. This can occur when the eyes are open or closed. Another symptom you may experience is dryness of the eyes, or feeling as if there is something scratchy in your eyes. All of these symptoms can come and go.
OTHER SIGNS AND SYMPTOMS:
Blood Suger Abnormalities:
Hepatitis C can cause blood sugar abnormalities, either high or low. High blood sugar causes symptoms such as extreme thirst, frequent urination, fatigue, and weight loss. Low blood sugar causes light-headedness or dizziness, nausea, and weakness. The symptoms of low blood sugar are worst when you have not eaten anything for several hours, and are relieved by eating or drinking something. If you are having any of the symptoms of either high or low blood sugar, tell your health care provider right away. Chest Pain: Hepatitis C can cause chest pain. However, chest pain can also be a symptom of serious heart or lung disease. If you have chest pain, you must contact your health care provider immediately so he or she can find out the source of your pain.
Menstrual and Menopausal Changes:
Women with hepatitis C may have menstrual changes such as irregular periods, spotting, or increased premenstrual symptoms. Menopausal women may experience an increase in menopausal symptoms such as hot flashes and mood swings.
Palpitations:
A heart palpitation is involuntarily becoming aware of your heart beating. Palpitations occur in different forms. You may feel your heart is beating harder or faster than usual, or that it is beating irregularly. If you have palpitations, you need to tell your health care provider immediately so he or she can make sure you are not having a problem with your heart.
Sexual Changes:
Some people with hepatitis C have a decreased interest in sexual activity. Decreased sexual response and lack of intensity of sexual response have also been reported. Sexual changes can be an upsetting symptom of hepatitis C. If you are experiencing sexual changes, talk with your health care provider, and your spouse or partner. There are things that you, your health care provider, and your partner can do to help you have a satisfying sex life.
SIGNS AND SYMPTOMS OF HEPATITIS C WITH CIRRHOSIS
Approximately 20-40% of people with chronic hepatitis C go on to develop liver cirrhosis over a period of 10-40 years. Because blood cannot flow well through a cirrhotic liver, blood backs up in the vessels leading to the liver. This back up of blood leads to an increase in pressure in those blood vessels, a condition known as portal hypertension . Many of the signs and symptoms of cirrhosis are related to portal hypertension. The liver has many functions, so there are a number of things that can go wrong when the liver is not functioning normally. The liver not functioning normally causes the other signs and symptoms of hepatitis C with cirrhosis.
Ascites:
Portal hypertension associated with cirrhosis can cause fluid to leak from the blood vessels leading to the liver. This fluid builds up in the abdomen and is called ascites. Ascites causes the abdomen to become distended or enlarged.
Bleeding Problems:
The liver produces many of the substances needed for normal blood clotting. A cirrhotic liver may not produce enough of these substances for normal clotting. If you have a cirrhotic liver and begin bleeding for any reason, it may be difficult to get the bleeding stopped.
Bone Pain:
Cirrhosis can lead to a deficiency in vitamin D. This can cause softening of the bones and bone pain. This pain is most often felt in the legs, hips, and spine.
Bruising:
Cirrhosis can lead to a deficiency in vitamin K. This can lead to easy bruising. If you are experiencing easy bruising, tell your health care provider because this symptom can often be reversed with appropriate treatment.
Caput Medusae:
Caput medusae refers to enlarged, visible veins that start at the navel and spread out and up over the abdomen. They are caused by portal hypertension.
Gastroesophageal Varices:
Gastroesophageal varices are another complication of portal hypertension. These varices are enlarged, fragile veins found where the esophagus (the tube that takes food from your mouth to your stomach) meets the stomach.
These veins can burst and bleed. If you have cirrhosis and begin to vomit blood, you must call an ambulance and get to an emergency room as soon as possible to get the bleeding stopped.
Glossitis: Glossitis is a sore tongue.
If you have glossitis, your tongue will be redder than usual and will be sensitive to salty and sour foods, and carbonated beverages.
Hemorrhoids:
Hemorrhoids are enlarged, fragile veins found around the anus (the opening through which your bowel movements pass). Hemorrhoids can be a complication of portal hypertension. If you have hemorrhoids, they may bleed occasionally. If the bleeding persists, or is frequent, be sure to discuss it with your health care provider.
Hepatic Encephalopathy:
Hepatic encephalopathy is one of the most serious complications of cirrhosis. It can occur in an acute form that develops over a period of days to weeks, or it can occur in a chronic form that develops over a period of months to years. There are a number of different symptoms that can indicate hepatic encephalopathy, but all of them indicate abnormalities of the nervous system. Early symptoms include euphoria (feeling unusually happy for no apparent reason) or depression, confusion, slurred speech, or abnormal sleeping patterns. If these symptoms are not treated, they will progress to severe confusion, incoherent speech, tremors, and rigidity. It is urgent for these symptoms to be treated or you could fall into a coma. With the acute form of hepatic encephalopathy, treatment will usually reverse all of the symptoms. However, with the chronic form, some of the symptoms may not be reversible.
Melanosis:
Melanosis is a gradual darkening of those areas of skin that are exposed to the sun. The skin tends to get darker over time.
Night Blindness:
Cirrhosis can lead to a deficiency in vitamin A. This can lead to episodes of night blindness. If this occurs, be certain to talk about it with your health care provider because this symptom is often reversible.
Shortness of Breath:
Shortness of breath can develop as a complication of portal hypertension. Some people experience this symptom only at night; others experience it during the day as well. If you are having shortness of breath, discuss it with your health care provider who can help you with this problem.
Steatorrhea:
Steatorrhea is the passing of fat in your bowel movements. The presence of fat in the stool makes the stool smell particularly bad, and causes it to float in the toilet bowl. Steatorrhea is usually accompanied by an increased amount of stool and intestinal gas.
Xanthelasma:
Xanthelasmas are small deposits of fat just under the surface of the skin around your eyes. They appear as small, raised, yellowish bumps on the skin. Xanthoma: Xanthomas are small deposits of fat just under the surface of the skin over your joints and/or tendons. They appear as small, raised, yellowish nodules.
SUMMARY: The experience of living with hepatitis C is quite different from one person to another. It is also variable for each person over time. There will probably be days when you feel great. There may be other times when you feel overwhelmed by different signs or symptoms associated with hepatitis C. And there will likely be still other times when you feel somewhere in between these two states. Below are a few things you may find helpful to keep in mind about your signs and symptoms as you learn to live with hepatitis C. Discuss your signs and symptoms with your health care provider. There are many ways to treat the signs and symptoms associated with hepatitis C, so there is no need to suffer in silence. Always tell your health care providers if you start to experience a new sign or symptom. Doing this will help them in their efforts to help you feel your best. Keep all of your health care providers informed about what treatments, medicines, and supplements you are using to manage your hepatitis C. Sometimes, different treatments interact with one another in ways that cause side effects that you may experience as new signs or symptoms. Do not panic if you start to experience new signs or symptoms. Although many of the signs and symptoms associated with hepatitis C can be troubling to you, they do not necessarily mean your liver disease is getting worse.
http://web.archive.org/web/20061112124655/http://www.hepcchallenge.org/manual/signs_symptoms_final.htm
Another great resource is the free online book : HCV Choices
Individual chapters are available below in PDF format, or you can download the complete book here (9.23MB)
Hepatitis C is the most common liver disease currently seen in clinical practice. The incubation period, from the time of exposure to the virus until the onset of the disease, is one to six months. Early symptoms include poor appetite, lack of interest in food, nausea, aching muscles and joints, and light fever. Some people experience only mild symptoms such as tiredness, periodical pressure below the right ribs caused by the enlarging liver, and aching muscles and joints. Only 1 in 10 patients with acute Hepatitis has symptoms. The remaining nine have no symptoms whatsoever. In 8 out of 10 patients, the infection becomes chronic.
Symptoms of Acute Viral Hepatitis
General Symptoms. Symptoms of acute viral hepatitis may begin suddenly or develop gradually. They may be so mild that patients mistake the disease for the flu. Nearly all patients experience some fatigue and often have mild fever. Gastrointestinal problems are very common, including nausea and vomiting and a general feeling of discomfort in the abdomen or a sharper pain that may occur in the upper right area if the abdomen. This pain tends to increase during jerking movements, such as climbing stairs or riding on a bumpy road. GI problems can lead to loss of appetite, weight loss, and dehydration. After about two weeks, dark urine and jaundicea yellowish color in the skin and whites of the eyes -- develops in some, but not all, patients. Children tend not to develop jaundice. About half of all hepatitis patients have light colored stools, muscle pain, drowsiness, irritability, and itching -- usually mild. Diarrhea and joint aches occur in about a quarter of patients. The liver may be tender and enlarged and most people have mild anemia. In about 10% of patients, the spleen is enlarged.
Symptoms of Fulminant Hepatitis. In very rare cases, within two months of onset, a very serious condition known as fulminant hepatitis develops. Symptoms may include a large swollen abdomen (known as ascites) and a peculiar hand-flapping tremor (called asterixis). These symptoms may be followed by stomach and intestinal bleeding and mental confusion, stupor, or coma caused by brain injury (encephalopathy).
Symptoms Typical of Acute Hepatitis A. Symptoms of hepatitis A are usually mild, especially in children. They generally appear between two and six weeks after exposure to the virus. Adult patients are more likely to have fever, jaundice, and itching that can last one to several months.
Symptoms Typical of Acute Hepatitis B. Hepatitis B symptoms appear long after the initial infectionusually four to 24 weeks. Many patients may not even experience symptoms, or they may be mild and flu-like. About 10% to 20% of patients have a fever and rash. Nausea is not common. Hepatitis B patients may experience general aching in the joints, but sometimes the pain can resemble arthritis, affecting specific joints and accompanied by redness and swelling.
Symptoms Typical of Acute Hepatitis C. If they appear at all, symptoms develop about a month or two after a person is infected with hepatitis C. These are usually milder than those of hepatitis B. About 75% of patients show no signs of jaundice, and many do not experience any symptoms.
Symptoms of Chronic Hepatitis
Symptoms of Chronic Hepatitis B and C. Both hepatitis B and C can progress to chronic hepatitis usually with no early acute symptoms. Symptoms of progressive chronic viral hepatitis may be very subtle and no more than a mild persistence of acute symptoms for six or more months. In fact, chronic hepatitis C can be present for as long as 20 years without presenting any obvious problems. In some patients, itchy skin may be the first symptom. Some patients develop pain in small joints in the body (such as the hand) that may be nearly indistinguishable from symptoms of rheumatoid arthritis, fibromyalgia, or carpal tunnel syndrome. In other patients, chronic hepatitis B or C can lead to long term disability or liver failure before they experience any symptoms at all.
SIGNS AND SYMPTOMS THAT MAY BE ASSOCIATED WITH HEPATITIS C
Many patients remain asymptomatic until decompensation occurs. Lack of symptoms and minor liver enzyme elevations are typical of HCV infection and cannot be taken as evidence of lack of progression. HCV RNA testing confirms the diagnosis. Liver biopsy helps assess disease activity and stage the severity of fibrosis and is recommended for most patients with hepatitis C. Once this information is obtained, a rational program for treatment and monitoring can be planned. Patients with newly discovered hepatitis C infection require thorough education about the disease's natural history, transmission, interaction with alcohol, and treatment. In many cases, referral to a gastroenterologist or hepatologist may be the appropriate way to ensure necessary instruction and availability of the latest treatment options.
(Tina M. St. John, MD )
INTRODUCTION:
Hepatitis C affects different people in different ways. Your personal experience with hepatitis C will be as unique as you are. This chapter reviews the most common signs and symptoms experienced by people with chronic hepatitis C. At first glance, the mere length of the chapter may appear overwhelming, but keep in mind, this is just a list of possibilities. If you have any of the signs or symptoms described in this chapter, it is important that you do not assume they are a result of having hepatitis C. Your health care provider can determine if they are associated with your hepatitis C. Very few people experience all of these signs and symptoms. Many of them will come and go on their own. For troublesome and/or persistent problems, there are things you and your health care provider can do to either make them go away, or make them easier to live with.
You may be wondering what the difference is between a sign and a symptom. A sign is an abnormality that is detected by your health care provider during an examination. A symptom is something you, as a person with hepatitis C, experience as a result of the disease. Signs and symptoms are discussed together because sometimes a sign is also a symptom. Fever is a good example of something that is both a sign and a symptom. Your health care provider can take your temperature and find out that you have a fever, so it is a sign. But if you have a fever, you can tell you have a fever because your skin is warm, so fever is also a symptom.
There are three sections following this introduction.
The first section briefly explains how the hepatitis C virus causes disease. The second section reviews possible signs and symptoms that people with hepatitis C who do not have cirrhosis may experience. The last section reviews additional signs and symptoms that people with hepatitis C who have cirrhosis may experience.
HOW THE HEPATITIS C VIRUS CAUSES DISEASE:
According to current understanding, the hepatitis C virus (HCV) causes disease in two general ways. The first is by infecting cells. Once inside the cell, the virus directly damages or kills the cell. This mechanism is called cytopathic damage. The second way the hepatitis C virus causes damage is by provoking an immune response. The immune system is your body's way of protecting itself from invading agents such as viruses and bacteria. An overactive or misdirected immune response can damage infected cells and the normal surrounding tissue. This mechanism is called immunopathic damage. When HCV was first discovered, experts thought the virus infected only liver cells. However, more recent research has revealed that HCV also infects parts of the immune system, specifically the lymphatic system and peripheral blood mononuclear cells.
Experts now understand that hepatitis C is not just a liver disease but is a systemic disease, meaning it can affect nearly any organ of the body. As you read through the list of possible signs and symptoms associated with hepatitis C infection, you may find some of the symptoms you have been experiencing that you thought were caused by something else may actually be caused by hepatitis C. This is important because knowing why you are having a symptom is often the first step in alleviating the symptom, or making it less troublesome.
SIGNS AND SYMPTOMS OF HEPATITIS C WITHOUT CIRRHOSIS:
The possible signs and symptoms of hepatitis C without cirrhosis involve every organ system of the body. Although some of these symptoms can be quite uncomfortable, most of them do not indicate that your liver disease is getting worse. New symptoms should always be discussed with your health care provider so you can work together to keep your life with hepatitis C as active, productive, and enjoyable as possible.
Arthralgia:
Arthralgia is pain in the joints. Frequent sites of joint pain are the hips, knees, fingers, and spine, although any joint can be a source of pain. Arthralgia associated with hepatitis C can be migratory, meaning it moves around. You may have pain in your hip one day and in your knee the next. This symptom usually comes and goes, and is rarely present all the time. If you experience joint pain, it is important to talk with your health care provider before taking anything to treat the pain because some over-the-counter pain medicines (such as acetaminophen) are potentially harmful to the liver.
Fever, Chills, and Night Sweats:
Many people with HCV periodically experience fevers. The fevers are usually low, typically less than 101 degrees Fahrenheit. As the fever comes down, you may experience chills and sweating. You may have fevers only at night. If this happens, you may wake up with your bedclothes and/or your sheets wet with sweat. This experience is called night sweats.
Fatigue:
Fatigue is feeling tired, and nearly all people with hepatitis C experience fatigue at one time or another. The fatigue may be mild and relieved by naps or going to bed earlier. However, the fatigue can be severe at times, feeling like near exhaustion even after a full night of sleep. Fatigue experienced by people with hepatitis C may also be accompanied by increased feelings of anger, hostility, and depression.1 These feelings may persist even after the fatigue has passed.
Fluid Retention:
Fluid retention occurs when your body holds on to more water than it needs. The extra water leaks into the tissues. If you have fluid retention, you may notice swelling of your feet, ankles, fingers, and/or face. People with fluid retention often have frequent urination, especially at night.
Flu-like Syndrome:
People with hepatitis C can experience periodic flu-like syndromes. These episodes usually last a few days, rarely more than a week. The most common symptoms are fever, chills, headache, fatigue, and muscle aches.
Lymphadenopathy:
Lymphadenopathy is swelling of the lymph nodes. Lymph nodes are normally about the size of a pea or a kidney bean. Because HCV infects the lymphatic system, it frequently causes the lymph nodes to swell. The lymph nodes of the armpits, groin, and neck are relatively close to the skin surface, and are usually examined to see if you have lymphadenopathy. If you have lymphadenopathy, it may or may not be painful when you press on the swollen lymph nodes.
Myalgia: Myalgia is muscle pain or aching.
People with hepatitis C may experience myalgia. Usually, if you have this symptom, you will experience it as a generalized feeling. However, some people report having pain in only one area of the body. This symptom tends to come and go, and is rarely present all the time. If you experience muscle aches or pain, it is important to talk with your health care provider before taking anything to treat the pain because some over-the-counter pain medicines are potentially harmful to the liver.
Pruritus:
Pruritus is the medical word for itching. People with hepatitis C sometimes have pruritus. Often, it is limited to the palms of the hands and/or the soles of the feet. However, some people have generalized pruritus, meaning they itch all over.
Sleep Disturbances:
Insomnia is difficulty sleeping, and it may be part of your experience with hepatitis C. Insomnia can occur in different forms. You may have trouble falling asleep, or you may wake up often during the night. Some people report having unusually vivid, intense, and/or frightening dreams. Such dreams can contribute to insomnia. Spider Nevi: Spider nevi are small, red, spider shaped spots on the skin. They are usually less than ½ inch around. They are most commonly seen on the face and chest, but can occur anywhere on the skin. Spider nevi are painless and do not itch. Weakness: People with hepatitis C sometimes experience a sense of weakness. This symptom can vary from mild to severe, and tends to come and go.
Abdominal and Digestive System
Signs and Symptoms Abdominal Pain:
You may experience episodes of abdominal pain if you have hepatitis C. Pain on the right side just below the ribs is likely to be from the liver. People usually report this pain as being short, sharp, or stabbing. More constant, cramping pain closer to the middle of chest, but under the ribs, can be due to gall bladder problems that may accompany hepatitis C. You may experience pain elsewhere in the abdomen. If you experience any new pain in the abdomen, it is important for you to tell your health care provider right away so the source of the pain can be determined.
Pain and Liver Disease
In many patients that have been diagnosed with hepatitis and/or
liver disease, many complain of abdominal pain, located mostly in
the right upper quadrant, right flank or epigastric area. Although
less frequent, left upper quadrant and lower abdominal pain has
also been reported.
Abdominal pain:
The nervous system pathways that convey abdominal pain messages are
known as the visceral and somatic pathways. Both of these pathways
are part of the sympathetic nervous system. The visceral fibers are
sensitive to stretch and spasm but are not affected by temperature
or sectioning of the nerve. The somatic pathways innervate the
abdominal cavity wall, parietal peritoneum, and parts of the
diaphragm. These fibers are sensitive to pressure, tension,
traction, chemical and bacterial toxins, enzymes, infiltrative
processes and edema. The central parts of the diaphragm and biliary
tract have axon fibers that carry messages in conjunction with the
phrenic nerve and are responsible for complaints of referred pain
to the shoulder area.
Biliary system pain:
Gallbladder and biliary tract spasms can cause pain that radiates
to the right shoulder and subscapular area. Inflammation of the
gallbladder wall can cause localized subcostal pain and rebound
tenderness.
Intestinal pain:
Most acute or chronic abdominal pain is bowel related. Right upper
quadrant pain is frequently due to large bowel distention (hepatic
flexure area) and small bowel ileus producing spasms and/or cramps.
Pain in the left upper quadrant can also be caused by distention of
the colon in the splenic flexure area. Lower abdominal pain would
be more likely caused by bladder or rectal problems.
Liver pain:
Liver pain (right upper quadrant) is due to the distention of the
liver capsule which has pain receptors. Rapid increases in liver
size from inflammation (viral hepatitis or alcohol induced) or a
tumor are the most common causes of liver pain. When the liver
becomes cirrhotic, specific liver pain is rarely the cause of right
upper quadrant complaints.
Pancreatic pain:
In viral or alcohol induced liver disease, the pancreas may become
inflamed, stimulating somatic nerve endings, causing severe pain
that radiates to lateral quadrants, back and left shoulder, going
through the back. It is made worse by lying down and improved when
in the knee chest position or bending forward.
Splenic pain:
Splenomegaly or infarction of the spleen may be present with liver
disease. Pain complaints will be most likely right upper quadrant.
Pain in acute or chronic liver disease may be difficult to manage
due to the excretion of many analgesics by the liver and/or
kidneys. Reduced dosages, and careful monitoring of hematological
and neurological function is critical to prevent accumulation and
toxicity. Acute or chronic hepatic failure may lower plasma
clearance of opiates such as Morphine, prolong the terminal
elimination half-life, and increase oral bioavailability
(Hasselstrom, Eriksson, Persson, Rane, Svensson, and Sawa, 1990).
Non- opiate analgesics are often contraindicated in patients with
hepatic or renal dysfunction. Acute pain in the face of chronic
disease needs prompt investigation, to rule out ulcer,
gastrointestinal bleeding, thrombosis of the portal system or
spleen, presence of tumor or development of inflammation or
infection.
Appetite Changes and Weight Loss:
People with hepatitis C frequently experience changes in their appetites. You may find you no longer want the foods you once enjoyed. Many people find they are particularly put off by fatty foods and alcohol. For some, foods that are at room temperature or cold are more appealing than hot foods. The distaste for alcohol is actually good for you because alcohol increases the damage done to the liver by HCV. People with hepatitis C should not drink any alcohol including beer, wine, wine coolers, and mixed drinks. If changes in your appetite are causing you to lose weight, you need to discuss this with your health care provider because good nutrition is particularly important for people with hepatitis C.
Bloating:
Bloating is usually described by people with hepatitis C as a feeling of fullness in the abdomen. You may notice your clothes seem tight around your waist. This bloating may or may not be accompanied by weight gain.
Diarrhea and Irritable Bowel Syndrome:
Diarrhea can be experienced as unusually loose stools or an increase in the frequency of bowel movements, with or without a change in the consistency of the stool. If the diarrhea is accompanied by cramping abdominal pain and persists, it is often termed irritable bowel syndrome.
Indigestion and Heartburn:
Indigestion is usually experienced as an uncomfortable feeling of fullness in the stomach. It is often accompanied by queasiness and burping of a mixture of gas and stomach contents. When this occurs, you may notice a burning in your throat and/or a sour taste in your mouth. Heartburn is experienced as pain or burning in the chest under the breastbone. It, too, may be accompanied by burping of gas and stomach contents. Both indigestion and heartburn can be brought on by and last longer after a fatty meal.
Jaundice:
Jaundice is a yellowish discoloration of the skin and/or the whites of the eyes. It is caused by a yellow substance in the blood called bilirubin. The liver normally breaks down bilirubin. If the liver is not working normally, bilirubin can build up in the blood and begin to stain the skin. If the liver starts to work more normally, jaundice will fade or go away.
Nausea:
Nausea is the feeling that you may vomit. Hepatitis C may cause episodes of nausea. Although it is usually not accompanied by vomiting, it can be a very uncomfortable and debilitating symptom. If you are having nausea, talk with your health care provider because there are many ways to treat this symptom.
Cognitive, Mood, and Nervous System Signs and Symptoms
Cognitive Changes: Your cognitive ability refers to your ability to think clearly and to concentrate. Some people with hepatitis C notice they have changes in their cognitive ability. This can take several different forms. You may find you cannot concentrate for long periods of time, or you may notice your thought processes seem slower than usual. You may have a hard time coming up with words you want to say, or you may just feel mentally tired. These cognitive changes are sometimes called ‘brain fog.’ Like other symptoms of hepatitis C, these cognitive changes often come and go.
Depression:
Hepatitis C does not directly cause depression, but concerns about the disease and changes it may cause in your life can lead to depression. Some of the symptoms of depression include: • sleeping more or less than usual
• eating more or less than usual
• hopelessness
• helplessness
• irritability
• lack of interest in your usual activities, and
• feelings of sadness and/or despair most of the time
If you have one or more of these symptoms, you may have depression and should discuss what you are feeling with you health care provider.Depression can seriously interfere with your quality of life, and can make it difficult for you to do what you need to do to take care of yourself. Depression is nothing to be ashamed of, and it can be treated. If you have any of the symptoms of depression, talk to your health care provider right away.
Dizziness:
Some people experience dizziness as feeling as if they are going to faint. Others experience dizziness as disorientation, or feeling as if the world is spinning around them. Both of these can be symptoms of hepatitis C. If you are experiencing dizziness, talk with your health care provider because this can be not only troublesome for you, but also dangerous.
Headaches:
Headaches can be symptoms of hepatitis C. For some people, the headaches are mild, but for others, the headaches are severe. If you are having headaches, talk to your health care provider before taking any medicines for your headaches because some over-the-counter pain medicines can be harmful to your liver.
Mood Swings:
Hepatitis C can sometimes cause mood swings. Some people find this symptom is worse during the winter months.
Numbness or Tingling:
A significant number of people with hepatitis C have numbness or tingling in their extremities. Your extremities are those parts of your body that extend from the main part of your body, that is, your arms and legs, fingers and toes. Most people with numbness or tingling feel it in their fingers and toes, but it may extend into the arms and legs. Numbness is a decreased sense of feeling. In its most severe form, the affected areas have no sense of feeling. Tingling can sometimes be painful. People describe painful tingling as feeling like being stuck with pins. This symptom tends to come and go.
Visual Changes:
There are a number of visual changes that can accompany hepatitis C infection. You may find you are not seeing as clearly as you once did. Peripheral vision, that is, the ability to see things that are at the sides of your view, can also be diminished. Some people report seeing small specks called ‘floaters’ moving across their view. This can occur when the eyes are open or closed. Another symptom you may experience is dryness of the eyes, or feeling as if there is something scratchy in your eyes. All of these symptoms can come and go.
OTHER SIGNS AND SYMPTOMS:
Blood Suger Abnormalities:
Hepatitis C can cause blood sugar abnormalities, either high or low. High blood sugar causes symptoms such as extreme thirst, frequent urination, fatigue, and weight loss. Low blood sugar causes light-headedness or dizziness, nausea, and weakness. The symptoms of low blood sugar are worst when you have not eaten anything for several hours, and are relieved by eating or drinking something. If you are having any of the symptoms of either high or low blood sugar, tell your health care provider right away. Chest Pain: Hepatitis C can cause chest pain. However, chest pain can also be a symptom of serious heart or lung disease. If you have chest pain, you must contact your health care provider immediately so he or she can find out the source of your pain.
Menstrual and Menopausal Changes:
Women with hepatitis C may have menstrual changes such as irregular periods, spotting, or increased premenstrual symptoms. Menopausal women may experience an increase in menopausal symptoms such as hot flashes and mood swings.
Palpitations:
A heart palpitation is involuntarily becoming aware of your heart beating. Palpitations occur in different forms. You may feel your heart is beating harder or faster than usual, or that it is beating irregularly. If you have palpitations, you need to tell your health care provider immediately so he or she can make sure you are not having a problem with your heart.
Sexual Changes:
Some people with hepatitis C have a decreased interest in sexual activity. Decreased sexual response and lack of intensity of sexual response have also been reported. Sexual changes can be an upsetting symptom of hepatitis C. If you are experiencing sexual changes, talk with your health care provider, and your spouse or partner. There are things that you, your health care provider, and your partner can do to help you have a satisfying sex life.
SIGNS AND SYMPTOMS OF HEPATITIS C WITH CIRRHOSIS
Approximately 20-40% of people with chronic hepatitis C go on to develop liver cirrhosis over a period of 10-40 years. Because blood cannot flow well through a cirrhotic liver, blood backs up in the vessels leading to the liver. This back up of blood leads to an increase in pressure in those blood vessels, a condition known as portal hypertension . Many of the signs and symptoms of cirrhosis are related to portal hypertension. The liver has many functions, so there are a number of things that can go wrong when the liver is not functioning normally. The liver not functioning normally causes the other signs and symptoms of hepatitis C with cirrhosis.
Ascites:
Portal hypertension associated with cirrhosis can cause fluid to leak from the blood vessels leading to the liver. This fluid builds up in the abdomen and is called ascites. Ascites causes the abdomen to become distended or enlarged.
Bleeding Problems:
The liver produces many of the substances needed for normal blood clotting. A cirrhotic liver may not produce enough of these substances for normal clotting. If you have a cirrhotic liver and begin bleeding for any reason, it may be difficult to get the bleeding stopped.
Bone Pain:
Cirrhosis can lead to a deficiency in vitamin D. This can cause softening of the bones and bone pain. This pain is most often felt in the legs, hips, and spine.
Bruising:
Cirrhosis can lead to a deficiency in vitamin K. This can lead to easy bruising. If you are experiencing easy bruising, tell your health care provider because this symptom can often be reversed with appropriate treatment.
Caput Medusae:
Caput medusae refers to enlarged, visible veins that start at the navel and spread out and up over the abdomen. They are caused by portal hypertension.
Gastroesophageal Varices:
Gastroesophageal varices are another complication of portal hypertension. These varices are enlarged, fragile veins found where the esophagus (the tube that takes food from your mouth to your stomach) meets the stomach.
These veins can burst and bleed. If you have cirrhosis and begin to vomit blood, you must call an ambulance and get to an emergency room as soon as possible to get the bleeding stopped.
Glossitis: Glossitis is a sore tongue.
If you have glossitis, your tongue will be redder than usual and will be sensitive to salty and sour foods, and carbonated beverages.
Hemorrhoids:
Hemorrhoids are enlarged, fragile veins found around the anus (the opening through which your bowel movements pass). Hemorrhoids can be a complication of portal hypertension. If you have hemorrhoids, they may bleed occasionally. If the bleeding persists, or is frequent, be sure to discuss it with your health care provider.
Hepatic Encephalopathy:
Hepatic encephalopathy is one of the most serious complications of cirrhosis. It can occur in an acute form that develops over a period of days to weeks, or it can occur in a chronic form that develops over a period of months to years. There are a number of different symptoms that can indicate hepatic encephalopathy, but all of them indicate abnormalities of the nervous system. Early symptoms include euphoria (feeling unusually happy for no apparent reason) or depression, confusion, slurred speech, or abnormal sleeping patterns. If these symptoms are not treated, they will progress to severe confusion, incoherent speech, tremors, and rigidity. It is urgent for these symptoms to be treated or you could fall into a coma. With the acute form of hepatic encephalopathy, treatment will usually reverse all of the symptoms. However, with the chronic form, some of the symptoms may not be reversible.
Melanosis:
Melanosis is a gradual darkening of those areas of skin that are exposed to the sun. The skin tends to get darker over time.
Night Blindness:
Cirrhosis can lead to a deficiency in vitamin A. This can lead to episodes of night blindness. If this occurs, be certain to talk about it with your health care provider because this symptom is often reversible.
Shortness of Breath:
Shortness of breath can develop as a complication of portal hypertension. Some people experience this symptom only at night; others experience it during the day as well. If you are having shortness of breath, discuss it with your health care provider who can help you with this problem.
Steatorrhea:
Steatorrhea is the passing of fat in your bowel movements. The presence of fat in the stool makes the stool smell particularly bad, and causes it to float in the toilet bowl. Steatorrhea is usually accompanied by an increased amount of stool and intestinal gas.
Xanthelasma:
Xanthelasmas are small deposits of fat just under the surface of the skin around your eyes. They appear as small, raised, yellowish bumps on the skin. Xanthoma: Xanthomas are small deposits of fat just under the surface of the skin over your joints and/or tendons. They appear as small, raised, yellowish nodules.
SUMMARY: The experience of living with hepatitis C is quite different from one person to another. It is also variable for each person over time. There will probably be days when you feel great. There may be other times when you feel overwhelmed by different signs or symptoms associated with hepatitis C. And there will likely be still other times when you feel somewhere in between these two states. Below are a few things you may find helpful to keep in mind about your signs and symptoms as you learn to live with hepatitis C. Discuss your signs and symptoms with your health care provider. There are many ways to treat the signs and symptoms associated with hepatitis C, so there is no need to suffer in silence. Always tell your health care providers if you start to experience a new sign or symptom. Doing this will help them in their efforts to help you feel your best. Keep all of your health care providers informed about what treatments, medicines, and supplements you are using to manage your hepatitis C. Sometimes, different treatments interact with one another in ways that cause side effects that you may experience as new signs or symptoms. Do not panic if you start to experience new signs or symptoms. Although many of the signs and symptoms associated with hepatitis C can be troubling to you, they do not necessarily mean your liver disease is getting worse.
http://web.archive.org/web/20061112124655/http://www.hepcchallenge.org/manual/signs_symptoms_final.htm
Another great resource is the free online book : HCV Choices
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