Typical Symptoms

 

4 phases of HCV infection: Acute, Chronic, Cirrhosis, & De-compensation/Failure
4 phases of HCV infection: Acute, Chronic, Cirrhosis, & De-compensation/Failure

DO NOT SELF-DIAGNOSE.  The list of symptoms below is not exhaustive, and overlaps with symptom lists of many other diseases. A diagnosis of hepatitis C requires further confirmation through medical testing.
Important points:

  • Most people with hepatitis C virus (HCV) are asymptomatic (no symptoms) for many years.
  • There are four major phases of hepatitis c (acute, chronic, cirrhosis, and de-compensation/failure), each with its own possible symptoms.
  • It is highly unlikely that anyone will have all the possible symptoms of a phase; very often they will have none of them.
  • Everyone is unique in the way their body reacts to HCV.
  • Often abnormal blood tests are the only signs of infection; even these are sometimes normal for many years while serious damage is being done to the liver.
  • Use of alcohol or co-infection with HIV worsens the symptoms and hastens the progression of hepatitis C.

Possible Symptoms of Acute hepatitis C

  • almost indistinguishable from acute hepatitis B infection
  • frequently asymptomatic (there are no symptoms), even when liver tests are abnormal
  • flu-like illness with fatigue, fever, muscular aches and pain, nausea and vomiting
  • about 10% of patients become jaundiced (their skin turns yellow)
  • generally these symptoms resolve and the patient has no symptoms of liver disease for many years
  • symptoms may occur from two weeks to six months after exposure but usually within two months.

Possible Symptoms of Chronic hepatitis C (in general order of frequency) – View images of “Stages 1 – 3” in Stages of Liver Disease.

  • fatigue, ranging from no symptoms at all, to gradually progressive fatigue and lack of energy, to complete debility; can vary widely between individuals and over time
  • joint and muscle pain
  • memory loss and mental confusion
  • skin problems such as dry or itchy skin, rashes, and spots, red palms, spider veins, lichen planus
  • depression, anxiety, irritability
  • indigestion, nausea, vomiting, gas, constipation or diarrhea, and inability to digest certain foods (especially common: some fats, proteins, and dairy products)
  • metabolic syndrome, pre-diabetes, fatty liver disease
  • sleep disturbances
  • pain or discomfort in abdomen, especially upper right quadrant
  • loss of libido
  • chills, sweating, hot/cold flashes
  • eye or eyesight problems, dry eyes
  • hyper-sensitivity to heat or cold
  • vertigo, dizziness, lack of coordination, tinnitus, hearing loss
  • flu-like symptoms
  • headaches
  • urinary tract infections, kidney infections, and strange odor or colouration to the urine
  • fever
  • slow healing and recovery
  • susceptibility to illness, infection, flu (or sometimes the opposite -some have an usually low susceptibility to illness due to a hyperactive immune system continually fighting HCV)
  • weight gain, water retention, swelling of stomach, legs, or feet (edema)
  • menstrual problems
  • appetite loss/weight loss
  • oral or mouth sores or dental problems, dry mouth
  • excessive bleeding (nosebleeds, longer clotting time, occasional bloody stools)
  • various autoimmune disorders such as sicca syndrome, chronic polyarthritis, polydermatomyositis, fibromyalgia, autoimmune thyroiditis, lung fibrosis, and diabetes mellitus may develop
  • extra-hepatic effects of HCV (those affecting organs other than liver) can impact kidneys and urinary tract system, skin, joints and bones (including osteoporosis – even in men and young people), blood vessels, heart and circulatory system (including vasculitis and heart disease), nervous system and brain

 

normal_and_fatty_livers
Fatty liver can greatly worsen symptoms of Chronic HCV.

Possible Symptoms of Hepatitis C-related Cirrhosis – View images of “Stage 4” in Stages of Liver Disease.

  • all of symptoms of chronic hepatitis C increase in severity, plus the following
  • progressively more severe fatigue
  • increased loss of appetite and loss of weight
  • easy bruisability
  • jaundice (yellow skin)
  • icterus (yellow eyes)
  • dark urine (the color of cola)
  • ascites or abdominal fluid accumulation and swelling (one symptom of this is sudden weight gain)
  • bleeding into the stomach, bloody stool and variceal rectal bleeding (caused by portal hypertension)
  • bleeding into the esophagus and variceal oral bleeding, coughing up/vomiting blood (caused by portal hypertension)
  • muscle wasting
  • swelling of spleen
  • severe itching (caused by bilirubin buildup under skin)
  • mild encephalopathy resulting in forgetfulness, disorientation and/or confusion

Possible Symptoms of Hepatitis C-related Liver De-compensation and Failure (end-stage liver disease)

  • all of symptoms of hepatitis C-related Cirrhosis increase in severity, plus the following
  • liver cancer (HCC or hepatocellular carcinoma)
  • kidney failure
  • life-threatening variceal bleeding – oral or rectal
  • severe ascites or swelling of abdomen
  • severe encephalopathy resulting in debilitating disorientation, dementia, and/or hepatic coma

For more details on the symptoms and how to deal with them, see HepCBC’s FAQs.