Hepatitis C is one of the more common types of viral hepatitis infections. There are around 30,000 new infections in the United States every year and it leads to about 8,000 to 10,000 deaths annually. Close to 4 million Americans are infected with the hepatitis C virus and about 2.7 million have a chronic infection. Globally there are over 150 million people living with the hepatitis C virus.
Most of the time the hepatitis C virus is spread among intravenous (IV) drugs users with a smaller percentage occurring as a result of sexual contact. Acute hepatis C infection is usually asymptomatic (silent) and a minority of cases may resolve spontaneously. Almost 75% of infections become chronic and causes extensive liver damage over a long period of time. It is these chronic infection cases that are more likely to be symptomatic.
Read more about hepatitis C.
How To Spot Hepatitis C Infection
Acute hepatitis C infection is usually silent but so is chronic infection to initially. At most there may be non-specific symptoms, like fatigue and malaise, for long periods of time in chronic infections until there is significant liver damage to cause symptoms. However, not all of these symptoms can be immediately attributed to liver disease. The following are some of the more likely liver symptoms to arise in chronic hepatitis in particular.
Jaundice and Itching
Jaundice is a common sign of many different types of liver disease, including viral hepatitis. It is evident as yellow discoloration of the skin, sclera (‘whites’) of the eyes and inner lining of the mouth. This yellowing is a result of a build up of bilirubin in the body. It is constantly produced as a byproduct of red blood cell breakdown.
Bilirubin is also constantly expelled from the body in the urine and stool. However, in liver disease the bilirubin cannot be properly processed by the liver and it accumulates in the bloodstream. It is eventually deposited in the skin and mucous membranes to cause yellowing. It appears that this bilirubin along with some other compounds from the liver ares responsible for itching associated with jaundice.
Easy Bruising and Bleeding
The liver is responsible for producing a host of different chemicals that influence blood clotting. These clotting factors as it is known are disrupted when the liver is diseased. As a result there are problems with blood clotting in the event of an injury. Even a minor break in the skin and underlying blood vessels can lead to prolonged bleeding.
When there is bleeding under the skin then this may be evident as bruising. Most of the time, we never see these small bleeds that occur because a clot quickly seals it. However, when there is liver disease like hepatitis C then this clotting is delayed and bruising appears with even minor injuries.
Dark Urine and Pale Stool
Normally bilirubin is passed out in the stool and urine. It is partly responsible for the characteristic tan to dark brown color of stool (stercobilin) and the light to dark yellow color of urine (urobilin).Bilirun enters the bowels in bile that is secreted from the gallbladder whereas the kidneys filter out bilirubin from the blood into the urine.
However, when this bilirubin cannot be properly processed by the diseased liver then it cannot be expelled in bile. The stool therefore becomes lighter in color to a pale hue. With reduced expulsion of bilirubin in the bile, more is then expelled in the urine. As a result the urine becomes darker in color.
Abdominal and Leg Swelling
Liver disease also affects the kidney’s ability to regulate the fluid levels in the body as well the balance of fluid within the tissue spaces and bloodstream. This is due to several mechanisms including disturbances in blood proteins like albumin which are produced by the liver as well as a build up in the pressure within the main vein to the liver.
There is a build up of blood returning to the heart and fluid seeps out of the blood vessels and into the tissue spaces. In addition, the kidneys do not properly filter the blood and regulate the reabsorption of water. This lead to fluid accumulation within the legs (peripheral edema) and eventually in the abdominal cavity (ascites).
Confusion and Drowsiness
Brain function is affected with prolonged and severe liver disease. This impact on the brain is known as hepatic encephalopathy and is seen in cirrhosis due to any cause, including chronic hepatitis C infection. It is believed to be due to a build up of toxins like ammonia in the brain, which are normally broken down by a healthy liver.
Hepatic encephalopathy can present with a host of signs and symptoms such as confusion, drowsiness, impaired memory and poor concentrations. In advanced cases there may be disorientation, slurred speech, abnormal shaking and agitation. These symptoms can sometimes be mistaken for intoxication.
How does Hepatitis C Cause Death?
The liver is versatile organ that is responsible for a host of different functions. Many of thes functions are essential for sustaining life. Chronic hepatitis C infection eventually results in a condition known as cirrhosis. This is a late stage of liver disease where there is a substantial loss of functioning liver cells and extensive scarring of the liver. There are several resons why this can lead to death.
Cirrhosis affects the body’s immune system which increases the risk of infections. It also increases the risk of liver cancer (hepatocellular carcinoma). In addition the buildup of toxins in the body can reach lethal levels. There may be also an impact on other organs which can result in multi-organ failure. Cirrhosis is irreversible and death can only be prevented with a liver transplant.
Cirrhosis develops in about 20% of chronic hepatitis C infection cases usually occurring within 20 years (1). Always speak to a doctor about the long term management of chronic hepatitis C infection. It is important that people living with chronic infection make the necessary lifestyle changes, undergo regular screening and maintain prescribed treatment to delay or possibly even prevent the onset of cirrhosis.