Clinical Symptoms and Signs

Many people with chronic hepatitis C have no symptoms of liver disease. If symptoms are present, they are usually mild, nonspecific, and intermittent. They may include:

fatigue

mild right-upper-quadrant discomfort or tenderness

nausea

poor appetite

muscle and joint pains

Similarly, the physical exam is likely to be normal or show only mild enlargement of the liver 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

ascites

ankle swelling

Extrahepatic Manifestations
Complications that do not involve the liver develop in 1 to 2 percent of people with hepatitis C. The most common is cryoglobulinemia, which is marked by:

skin rashes, such as purpura, vasculitis, or urticaria

joint and muscle aches

kidney disease

neuropathy

cryoglobulins, rheumatoid factor, and low complement levels in serum

Other complications of chronic hepatitis C are:

glomerulonephritis

porphyria cutanea tarda

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

fibromyalgia

lichen planus