Symptoms

Many people with chronic hepatitis C are asymptomatic of liver disease. If symptoms are present, they are usually mild, non-specific, and intermittent.

They may include

• Fatigue.
• Mild right upper quadrant pain or tenderness.
• Nausea.
• Poor appetite.
• Muscle and joint pains.

Signs

Similarly, the physical exam is likely to be normal or show only mild hepatomegaly or tenderness. Some patients have vascular spiders or palmar erythema.

Clinical Features of Cirrhosis

Once a patient develops cirrhosis or if the patient has severe disease, symptoms and signs are more prominent. In addition to fatigue, the patient may complain of muscle weakness, poor appetite, nausea, weight loss, itching, dark urine, fluid retention, and abdominal swelling.

Physical findings of cirrhosis may include

• Enlarged liver.
• Enlarged spleen.
• Jaundice.
• Muscle wasting.
• Excoriations.

Extra-Hepatic Manifestations

One to two percent of people with hepatitis C develop extra-hepatic manifestations. The most common of these is cryoglobulinemia, which is marked by

• Skin rashes, such as purpura, vasculitis, or urticaria.
• Joint and muscle aches.
• Kidney disease.
• Neuropathy.
• The presence of cryoglobulins, rheumatoid factor, and low complement levels in serum.

Other extra-hepatic manifestations of chronic hepatitis C are

• Glomerulonephritis (which may be linked to cryoglobulinemia).
• Porphyria cutanea tarda (which occurs in patients with many forms of liver disease).

Diseases that are less well documented to be related to hepatitis C are

• Seronegative arthritis.
• Keratoconjunctivitis sicca (Sjögren's syndrome).
• Non-Hodgkin's type, B-cell lymphomas.

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