Hepatitis C: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Prognosis

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Hepatitis C

1Overview

Hepatitis C is another viral infection caused by hepatitis C virus (HCV), a Hepatovirus affecting the liver. It is highly contagious causing the liver to be inflamed that may lead to serious liver damage (cirrhosis), liver failure, liver cancer and even death.

In the United States, there are about 2.7 to 3.9 million people who live with hepatitis C infection and more than 75 percent of these people, mostly adults, are infected with chronic hepatitis C. The hepatitis C virus may not produce symptoms until decades after infection that is why many people don’t know they contracted hepatitis C already.

In children, hepatitis C is less common. Most children contracted the disease at birth. If the mother has hepatitis C infection, there is a chance that the child might have the disease also. But most children who contracted the disease at birth will be resolved at the age of 2 years old.

Hepatitis C in adolescents can be contracted through sharing of intravenous (IV) needles or injections during drug use and engaging in a risky sexual activity.

2Symptoms

Most people with hepatitis C do not manifest signs and symptoms in the early stages. It may develop years when liver damage occurs. Others may develop the symptoms between 2 weeks to 6 months after infection and the average time for symptoms to develop is six to seven weeks after the acquisition.

Acute Hepatitis C Infection

This refers to signs and symptoms that are short term and appear within six months of newly acquiring the virus. These are usually mild and do not progress to liver failure.

Chronic Hepatitis C Infection

This refers to long lasting infection where there is the replication of virus for at least six months. Chronic hepatitis C can last for your entire life since the virus remains in the body for many years until it damages the liver enough causing the manifestations of liver disease. Among these manifestations can be mild to severe:

  • Fatigue
  • Poor appetite
  • Dark-colored urine
  • Itchy skin
  • Yellow discoloration of the skin and eyes (jaundice)
  • Bleeding easily
  • Bruising easily
  • Fluid buildup in your abdomen (ascites)
  • Swelling in your legs
  • Weight loss
  • Confusion, drowsiness and slurred speech (hepatic encephalopathy)
  • Spider-like blood vessels on your skin (spider angiomas)

The majority of those who contracted the acute hepatitis C infection develop the chronic infection, though acute hepatitis C does not always become chronic. After the contraction of acute hepatitis C, some people clear HCV from their bodies.

3Causes

Hepatitis C infection, caused by hepatitis C virus (HCV), is a blood-borne illness, meaning the HCV is spread through contaminated blood. Mostly, the virus enters the body via an opening, cut or a punctured wound.

Drug users who share needles with an infected person and health care professionals (especially those working in the laboratories, hemodialysis centers, and those giving blood transfusions) having been pricked with a needle, are likely to contract hepatitis C.

An individual cannot catch the hepatitis C virus from simply being around infected people, shaking hands, embracing or hugging.

4Risk Factors

The following have a higher risk of contracting hepatitis C virus:

  • One in every 30 baby boomers has hepatitis C that is those born between 1945-1965 should be tested.
  • Intravenous drug users or have injected illicit drugs
  • Health care workers who have been exposed to infected blood from a needle stick injury (e.g. hemodialysis workers and clients; laboratory workers in the hospital)
  • Individuals with Human Immunodeficiency Virus (HIV)
  • Those engaging in sexual practices having higher levels of trauma (anal-penetrated sex) especially when one is infected with the hepatitis C virus.
  • Those who do body modification or submit themselves to it like tattoo or body piercing in an unclean environment using the unsterile
  • Those who gave and received blood transfusion or organ before 1992, where the reliable testing for hepatitis C in donated blood began.
  • Those who received hemodialysis treatment for a long period
  • Those who were born to woman with a hepatitis C infection.
  • Those who share their items (towels, shavers, toothbrush,)

5Complications

Hepatitis C infection can cause hepatomegaly (enlargement of the liver), splenomegaly (enlargement of the skin) and bleeding. But the most significant complications are the scarring of the liver called cirrhosis, liver cancer, and liver failure.

The scarring of the liver (cirrhosis) has developed 20 years to 30 years after the individual becomes infected. Scarring happens because the regeneration of the cells in the liver is incomplete.

The liver becomes damaged because of the scarred tissue that gradually replaces the healthy tissue of the liver thus partially blocks the flow of blood to the liver. This prevents then the liver from functioning properly.

During the early stage of this disease,  there are no symptoms but as it progresses and worsens, the individual experiences the following:

  • Tiredness and weakness
  • Loss of appetite
  • Weight loss
  • Feeling sick
  • Very itchy skin
  • Tenderness or pain in your tummy
  • Swelling on lower legs (edema)
  • Bloating of the abdomen due to the buildup of fluid in the abdomen (ascites)
  • Tiny red lines (blood capillaries) on the skin
  • Yellowing of the skin and whites of the eyes (jaundice)

Liver Cancer

Liver cancer or hepatic cancer is common in clients with liver cirrhosis. It happens when the normal cells in the liver become abnormal in appearance and behavior which can become destructive and can spread to the adjacent normal tissues of the liver or organs outside of the liver. Each year, it is estimated that around one in every 20 people with hepatitis-associated cirrhosis will develop liver cancer.

End-Stage Liver Disease

Liver failure is also called end-stage liver disease. Hepatitis viruses multiply in the liver cells causing the liver to lose its functions and so with advanced cirrhosis.

The liver does not perform its functions well when it is inflamed thus signs and symptoms and problems associated with hepatitis C appear.

The following are the functions of the liver:

  • It produces many important substances, especially proteins that are necessary for good health. The liver produces albumin, which is the protein building block of the body and is responsible for the blood to clot properly.
  • It helps purify the blood by changing harmful chemicals into harmless ones.
  • It stores many sugars, fats, and vitamins until they are needed elsewhere in the body.
  • It manufactures fat, cholesterol, and the protein bilirubin.

6Diagnosis

Aside from medical history taking and physical examination, several blood tests including hepatitis antibody test, imaging tests, and biopsy are ordered by the doctor to confirm that an individual has hepatitis C infection.

Medical History

The physician will ask about your symptoms that you manifest and whether you have any history of blood transfusions or injected drug use.

Physical Exam

The physician will typically examine your body to check for signs of liver damage, such as changes in skin color, swelling in your lower legs, feet, or ankles and tenderness or swelling in the abdomen.

Blood Tests

It is used to confirm hepatitis C infection. The physician may also order additional tests to check the extent of liver damage or rule out other causes of liver disease.

These blood test for hepatitis C are the following:

  • Screening test for antibodies to the hepatitis C virus-This test will show whether the client developed antibodies to the hepatitis C virus. A positive antibody test means you were exposed to the hepatitis C virus before.
  • Hepatitis C RNA test-If the blood test comes back positive, the doctor will do a second blood test, the hepatitis C RNA, to see if the virus is still present in your blood or whether the body resolves it on its own. It will also see how much virus is still in your blood.
  • Genotype test-This test is used to find out what strain, or form, of hepatitis C virus you have. There are at least six specific strains, called genotypes, of hepatitis C exist. Treatment will be based on what type of genotype you have.

Additional Tests

Transient Elastography

Transient elastography painlessly measures the elasticity (stiffness) of the liver tissue using an ultrasound that transmits vibrations into the liver and measures the speed of their dispersion through liver tissue to estimate stiffness. This procedure benefits some clients who refuse a liver biopsy since it is non-invasive.

Magnetic resonance elastography (MRE)

It is another noninvasive procedure to a liver biopsy. This combines magnetic resonance imaging technology with patterns formed by mechanical sound waves bouncing off the liver to create a quantitative image of tissue stiffness.

Liver biopsy

Liver biopsy is a procedure where the doctor uses a biopsy needle to take a small piece of tissue from your liver for pathological examination. This procedure helps the doctor to see the extent of the liver damage or any other disease. This is only done if other tests don’t provide enough information about the client’s liver damage. It confirms the diagnosis liver cirrhosis.

7Treatment

Medicines

Hepatitis C can be cured. There are recent scientific advances that have led to significant progress in managing Hepatitis C.

For Most people who are known to have an acute hepatitis C infection, they get treated with medicines which may help them prevent chronic infection. Acute hepatitis C responds well to antiviral therapy intended to clear the virus in the body. Just be very cautious when using any supplements and over- the- counter drugs which may lead to further liver damage. Ask your doctor before using them.

For chronic hepatitis C infection, it is much better to discuss the medications and treatment regimens to be used to a specialist. The choice of medications and the duration of treatment depend on the hepatitis C genotype, occurrence of existing liver damage and other medical conditions and previous treatments. Throughout the treatment, the health care team will monitor your response to medication.

Liver Transplantation

When treatment for complications is ineffective, and the cirrhosis leads to liver failure, a liver transplant may be considered. Liver transplantation is surgery where the doctor removes a diseased or a damaged liver and replace it with a healthy liver or part of a liver from a donor. Most transplanted livers come from a deceased donor and a small number of living donors who donate a portion of their liver.

However, a liver transplant alone doesn’t cure hepatitis C. The infection is most likely to return, thereby requiring treatment with an antiviral medication to prevent damage to the transplanted liver.

Vaccinations

There is no vaccine for hepatitis C infection. If the client has liver damage already, the doctor might recommend that she/he would receive vaccines against hepatitis A and hepatitis B to avoid further damage to the liver.

8Prevention

Make sure to practice these measures to protect yourself from contracting the hepatitis C infection.

  • Do not use illicit drugs.
  • Do not share IV needles, drug needles or other drug materials
  • Wear gloves if you have to touch another person’s blood or open sores.
  • Make sure your tattoo artist or body piercer uses sterile needles and tools.
  • Do not share personal items such toothbrushes, razors, or nail clippers.
  • Practice safe sex.
  • Seek consultation immediately once you suspect you might have contracted hepatitis C to prevent potential liver damage.

9Prognosis

If left untreated, clients with acute HCV infection will develop a chronic liver infection. With new research regarding screening clients who might have the disease and new technologies to be used for the treatment of hepatitis C infection, there will be less common or rare infection of hepatitis C in the future.