Hepatitis C: Characteristics, Symptoms and Phases

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Hepatitis C (HCV) is one of the main causes of chronic liver disease around the world. Worldwide, 3% of the population has HCV. In the United States over 2 million Americans are unaware that they have been infected with this silent, deadly disease. The prevalence of HCV infection is highest among those born between the years 1945 and 1965 (termed the baby boomer age group), among IV drug users, and the HIV positive population. The acute phase of HCV is typically asymptomatic, thus causing a delay in diagnosis for months, years, or even decades by which time it has advanced to the chronic stage where liver damage can be irreversible. HCV causes many complications including cirrhosis of the liver, hepatocellular carcinoma and death.

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As indicated by the Centers for Disease Control and Prevention, Hepatitis C (HCV) is characterized as an infectious hepatic disease caused by the hepatitis C infection. HCV is defined as an inflammation of the liver caused by a virus. It is a single stranded RNA virus from the family Flaviviridae, and now is accountable for more deaths and disease than the HIV/AIDS virus. In the US, there are approximately 4 million people suffering from HCV. Early detection and diagnosis are the only ways to stop this silent, deadly disease.

The signs and symptoms of HCV are many, varied and with most going unreported for years and decades, giving it the name “Silent Epidemic.” HCV has an incubation period of thirty-five to seventy-two days and replicates at a very high rate, mutating rapidly, which does not allow the body’s immune system to keep up with the ever-changing infection. Signs can range from fatigue and flulike symptoms in the beginning stages to jaundice, liver failure, liver cancer and death in the final stages. Many patients do not realize when they are in the acute phase (beginning phase) due to the generic flulike symptoms and may not know that they are entering the chronic phase (after 72 days) in which HCV can become dormant for years with no symptoms. HCV invades the liver cells directly, attacking liver cells one-by-one. Liver damage will depend upon the patient’s viral load.

The liver is the primary filtering organ of the body and is located on the right side of the body where it is attached to the diaphragm. It has two lobes with two blood supplies:

  • The hepatic artery which takes in oxygen rich blood from the heart.
  • The portal vein which supplies the liver with nutrient rich blood from the digestive tract.

The liver stores glycogen for energy use, as well as excretion, secretion, and detoxification of products such as bilirubin, alcohol, cholesterol and drugs. The liver also is the only organ to rid hemoglobin from the body.

The two phases of HCV are the acute phase and the chronic phase. After presentation of HCV, 85-90% of the two kinds of hepatitis are asymptomatic with some symptoms occurring during the acute phase (2-12 week). During the acute hepatitis phase, symptoms may consist of nausea, fatigue, vomiting, upper right quadrant pain, and myalgia. Most of the time the acute HCV phase symptoms will spontaneously resolve themselves, and 50-80% of the time HCV develops into the chronic phase after a six-month dormant period.

The body transitions to the chronic phase after the acute phase because the body’s immune system is unable to keep up with the ever-changing virus. This is largely due to the fact that the RNA virus is more aggressive than DNA viruses, making it harder for the body’s immune system to obliterate the virus. During the chronic phase, the symptoms and damage to the liver will depend on the person and will vary with many individuals advancing to end-stage liver diseases, such as cirrhosis, hepatocellular carcinoma. There are other factors that may come into play with the rate of progression that include: alcohol, age, gender, co-infection with HIV or Hep B, and fatty liver. Chronic infection occurs in 50-80% of cases which eventually leads to cirrhosis and hepatocellular carcinoma.

Stellate cells are fat cells that for the most part store vitamin A and help to regulate the flow of blood through the liver. When inflammation of the liver occurs, the stellate cell rids itself of vitamin A thus altering its structure, which leads to a condition called fibrous. These inflamed cells release chemical signals called cytokines, which in turn activate white blood cells that stimulate Kupffer cells to further produce more chemical signals stimulating the stellate cells to lay down collagen fibers. The development of these fibers becomes scar tissue that can ordinarily return to normal. In cases of chronic hepatitis, the scar tissues develop so quickly that the liver cannot properly repair itself causing the liver cells to lose access to blood carrying nutrients and oxygen that now cause cell death. The fibrous tissue and scarring on the liver is called cirrhosis. Cirrhosis can constrict the blood vessels causing the blood to be rerouted by abnormal vascular anatomic connections.

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