http://www.hepcchallenge.org/manual/signs_symptoms_final.htm/
Signs and Symptoms That May Be Associated with HCV
(Tina M. St. John, MD )
INTRODUCTION: Hepatitis C affects different people in different ways. Your personal experience with hepatitis C will be as unique as you are. This chapter reviews the most common signs and symptoms experienced by people with chronic hepatitis C. At first glance, the mere length of the chapter may appear overwhelming, but keep in mind, this is just a list of possibilities. If you have any of the signs or symptoms described in this chapter, it is important that you do not assume they are a result of having hepatitis C. Your health care provider can determine if they are associated with your hepatitis C. Very few people experience all of these signs and symptoms. Many of them will come and go on their own. For troublesome and/or persistent problems, there are things you and your health care provider can do to either make them go away, or make them easier to live with.
You may be wondering what the difference is between a sign and a symptom. A sign is an abnormality that is detected by your health care provider during an examination. A symptom is something you, as a person with hepatitis C, experience as a result of the disease. Signs and symptoms are discussed together because sometimes a sign is also a symptom. Fever is a good example of something that is both a sign and a symptom. Your health care provider can take your temperature and find out that you have a fever, so it is a sign. But if you have a fever, you can tell you have a fever because your skin is warm, so fever is also a symptom.
There are three sections following this introduction. The first section briefly explains how the hepatitis C virus causes disease. The second section reviews possible signs and symptoms that people with hepatitis C who do not have cirrhosis may experience. The last section reviews additional signs and symptoms that people with hepatitis C who have cirrhosis may experience.
HOW THE HEPATITIS C VIRUS CAUSES DISEASE: According to current understanding, the hepatitis C virus (HCV) causes disease in two general ways. The first is by infecting cells. Once inside the cell, the virus directly damages or kills the cell. This mechanism is called cytopathic damage. The second way the hepatitis C virus causes damage is by provoking an immune response. The immune system is your body’s way of protecting itself from invading agents such as viruses and bacteria. An overactive or misdirected immune response can damage infected cells and the normal surrounding tissue. This mechanism is called immunopathic damage.
When HCV was first discovered, experts thought the virus infected only liver cells. However, more recent research has revealed that HCV also infects parts of the immune system, specifically the lymphatic system and peripheral blood mononuclear cells. Experts now understand that hepatitis C is not just a liver disease but is a systemic disease, meaning it can affect nearly any organ of the body. As you read through the list of possible signs and symptoms associated with hepatitis C infection, you may find some of the symptoms you have been experiencing that you thought were caused by something else may actually be caused by hepatitis C. This is important because knowing why you are having a symptom is often the first step in alleviating the symptom, or making it less troublesome.
SIGNS AND SYMPTOMS OF HEPATITIS C WITHOUT CIRRHOSIS: The possible signs and symptoms of hepatitis C without cirrhosis involve every organ system of the body. Although some of these symptoms can be quite uncomfortable, most of them do not indicate that your liver disease is getting worse. New symptoms should always be discussed with your health care provider so you can work together to keep your life with hepatitis C as active, productive, and enjoyable as possible.
Arthralgia: Arthralgia is pain in the joints. Frequent sites of joint pain are the hips, knees, fingers, and spine, although any joint can be a source of pain. Arthralgia associated with hepatitis C can be migratory, meaning it moves around. You may have pain in your hip one day and in your knee the next. This symptom usually comes and goes, and is rarely present all the time. If you experience joint pain, it is important to talk with your health care provider before taking anything to treat the pain because some over-the-counter pain medicines (such as acetaminophen) are potentially harmful to the liver.
Fever, Chills, and Night Sweats: Many people with HCV periodically experience fevers. The fevers are usually low, typically less than 101 degrees Fahrenheit. As the fever comes down, you may experience chills and sweating. You may have fevers only at night. If this happens, you may wake up with your bedclothes and/or your sheets wet with sweat. This experience is called night sweats.
Fatigue: Fatigue is feeling tired, and nearly all people with hepatitis C experience fatigue at one time or another. The fatigue may be mild and relieved by naps or going to bed earlier. However, the fatigue can be severe at times, feeling like near exhaustion even after a full night of sleep. Fatigue experienced by people with hepatitis C may also be accompanied by increased feelings of anger, hostility, and depression. These feelings may persist even after the fatigue has passed.
Fluid Retention: Fluid retention occurs when your body holds on to more water than it needs. The extra water leaks into the tissues. If you have fluid retention, you may notice swelling of your feet, ankles, fingers, and/or face. People with fluid retention often have frequent urination, especially at night.
Flu-like Syndrome: People with hepatitis C can experience periodic flu-like syndromes. These episodes usually last a few days, rarely more than a week. The most common symptoms are fever, chills, headache, fatigue, and muscle aches.
Lymphadenopathy: Lymphadenopathy is swelling of the lymph nodes. Lymph nodes are normally about the size of a pea or a kidney bean. Because HCV infects the lymphatic system, it frequently causes the lymph nodes to swell. The lymph nodes of the armpits, groin, and neck are relatively close to the skin surface, and are usually examined to see if you have lymphadenopathy. If you have lymphadenopathy, it may or may not be painful when you press on the swollen lymph nodes.
Myalgia: Myalgia is muscle pain or aching. People with hepatitis C may experience myalgia. Usually, if you have this symptom, you will experience it as a generalized feeling. However, some people report having pain in only one area of the body. This symptom tends to come and go, and is rarely present all the time. If you experience muscle aches or pain, it is important to talk with your health care provider before taking anything to treat the pain because some over-the-counter pain medicines are potentially harmful to the liver.
Pruritus: Pruritus is the medical word for itching. People with hepatitis C sometimes have pruritus. Often, it is limited to the palms of the hands and/or the soles of the feet. However, some people have generalized pruritus, meaning they itch all over.
Sleep Disturbances: Insomnia is difficulty sleeping, and it may be part of your experience with hepatitis C. Insomnia can occur in different forms. You may have trouble falling asleep, or you may wake up often during the night. Some people report having unusually vivid, intense, and/or frightening dreams. Such dreams can contribute to insomnia.
Spider Nevi: Spider nevi are small, red, spider shaped spots on the skin. They are usually less than ½ inch around. They are most commonly seen on the face and chest, but can occur anywhere on the skin. Spider nevi are painless and do not itch.
Weakness: People with hepatitis C sometimes experience a sense of weakness. This symptom can vary from mild to severe, and tends to come and go.
Abdominal and Digestive System Signs and Symptoms
Abdominal Pain: You may experience episodes of abdominal pain if you have hepatitis C. Pain on the right side just below the ribs is likely to be from the liver. People usually report this pain as being short, sharp, or stabbing. More constant, cramping pain closer to the middle of chest, but under the ribs, can be due to gall bladder problems that may accompany hepatitis C. You may experience pain elsewhere in the abdomen. If you experience any new pain in the abdomen, it is important for you to tell your health care provider right away so the source of the pain can be determined.
Appetite Changes and Weight Loss: People with hepatitis C frequently experience changes in their appetites. You may find you no longer want the foods you once enjoyed. Many people find they are particularly put off by fatty foods and alcohol. For some, foods that are at room temperature or cold are more appealing than hot foods. The distaste for alcohol is actually good for you because alcohol increases the damage done to the liver by HCV. People with hepatitis C should not drink any alcohol including beer, wine, wine coolers, and mixed drinks. If changes in your appetite are causing you to lose weight, you need to discuss this with your health care provider because good nutrition is particularly important for people with hepatitis C.
Bloating: Bloating is usually described by people with hepatitis C as a feeling of fullness in the abdomen. You may notice your clothes seem tight around your waist. This bloating may or may not be accompanied by weight gain.
Diarrhea and Irritable Bowel Syndrome: Diarrhea can be experienced as unusually loose stools or an increase in the frequency of bowel movements, with or without a change in the consistency of the stool. If the diarrhea is accompanied by cramping abdominal pain and persists, it is often termed irritable bowel syndrome.
Indigestion and Heartburn: Indigestion is usually experienced as an uncomfortable feeling of fullness in the stomach. It is often accompanied by queasiness and burping of a mixture of gas and stomach contents. When this occurs, you may notice a burning in your throat and/or a sour taste in your mouth. Heartburn is experienced as pain or burning in the chest under the breastbone. It, too, may be accompanied by burping of gas and stomach contents. Both indigestion and heartburn can be brought on by and last longer after a fatty meal.
Jaundice: Jaundice is a yellowish discoloration of the skin and/or the whites of the eyes. It is caused by a yellow substance in the blood called bilirubin. The liver normally breaks down bilirubin. If the liver is not working normally, bilirubin can build up in the blood and begin to stain the skin. If the liver starts to work more normally, jaundice will fade or go away.
Nausea: Nausea is the feeling that you may vomit. Hepatitis C may cause episodes of nausea. Although it is usually not accompanied by vomiting, it can be a very uncomfortable and debilitating symptom. If you are having nausea, talk with your health care provider because there are many ways to treat this symptom.
Cognitive, Mood, and Nervous System Signs and Symptoms
Cognitive Changes: Your cognitive ability refers to your ability to think clearly and to concentrate. Some people with hepatitis C notice they have changes in their cognitive ability. This can take several different forms. You may find you cannot concentrate for long periods of time, or you may notice your thought processes seem slower than usual. You may have a hard time coming up with words you want to say, or you may just feel mentally tired. These cognitive changes are sometimes called ‘brain fog.’ Like other symptoms of hepatitis C, these cognitive changes often come and go.
Depression: Hepatitis C can directly cause depression. Some of the symptoms of depression include:
• sleeping more or less than usual
• eating more or less than usual
• hopelessness
• helplessness
• irritability
• lack of interest in your usual activities, and
• feelings of sadness and/or despair most of the time
If you have one or more of these symptoms, you may have depression and should discuss what you are feeling with you health care provider. Depression can seriously interfere with your quality of life, and can make it difficult for you to do what you need to do to take care of yourself. Depression is nothing to be ashamed of, and it can be treated. If you have any of the symptoms of depression, talk to your health care provider right away.
Dizziness: Some people experience dizziness as feeling as if they are going to faint. Others experience dizziness as disorientation, or feeling as if the world is spinning around them. Both of these can be symptoms of hepatitis C. If you are experiencing dizziness, talk with your health care provider because this can be not only troublesome for you, but also dangerous.
Headaches: Headaches can be symptoms of hepatitis C. For some people, the headaches are mild, but for others, the headaches are severe. If you are having headaches, talk to your health care provider before taking any medicines for your headaches because some over-the-counter pain medicines can be harmful to your liver.
Mood Swings: Hepatitis C can sometimes cause mood swings. Some people find this symptom is worse during the winter months.
Numbness or Tingling: A significant number of people with hepatitis C have numbness or tingling in their extremities. Your extremities are those parts of your body that extend from the main part of your body, that is, your arms and legs, fingers and toes. Most people with numbness or tingling feel it in their fingers and toes, but it may extend into the arms and legs. Numbness is a decreased sense of feeling. In its most severe form, the affected areas have no sense of feeling. Tingling can sometimes be painful. People describe painful tingling as feeling like being stuck with pins. This symptom tends to come and go.
Visual Changes: There are a number of visual changes that can accompany hepatitis C infection. You may find you are not seeing as clearly as you once did. Peripheral vision, that is, the ability to see things that are at the sides of your view, can also be diminished. Some people report seeing small specks called ‘floaters’ moving across their view. This can occur when the eyes are open or closed. Another symptom you may experience is dryness of the eyes, or feeling as if there is something scratchy in your eyes. All of these symptoms can come and go.
OTHER SIGNS AND SYMPTOMS:
Blood Sugar Abnormalities: Hepatitis C can cause blood sugar abnormalities, either high or low. High blood sugar causes symptoms such as extreme thirst, frequent urination, fatigue, and weight loss. Low blood sugar causes light-headedness or dizziness, nausea, and weakness. The symptoms of low blood sugar are worst when you have not eaten anything for several hours, and are relieved by eating or drinking something. If you are having any of the symptoms of either high or low blood sugar, tell your health care provider right away.
Chest Pain: Hepatitis C can cause chest pain. However, chest pain can also be a symptom of serious heart or lung disease. If you have chest pain, you must contact your health care provider immediately so he or she can find out the source of your pain.
Menstrual and Menopausal Changes: Women with hepatitis C may have menstrual changes such as irregular periods, spotting, or increased premenstrual symptoms. Menopausal women may experience an increase in menopausal symptoms such as hot flashes and mood swings.
Palpitations: A heart palpitation is involuntarily becoming aware of your heart beating. Palpitations occur in different forms. You may feel your heart is beating harder or faster than usual, or that it is beating irregularly. If you have palpitations, you need to tell your health care provider immediately so he or she can make sure you are not having a problem with your heart.
Sexual Changes: Some people with hepatitis C have a decreased interest in sexual activity. Decreased sexual response and lack of intensity of sexual response have also been reported. Sexual changes can be an upsetting symptom of hepatitis C. If you are experiencing sexual changes, talk with your health care provider, and your spouse or partner. There are things that you, your health care provider, and your partner can do to help you have a satisfying sex life.
SIGNS AND SYMPTOMS OF HEPATITIS C WITH CIRRHOSIS
Approximately 20-40% of people with chronic hepatitis C go on to develop liver cirrhosis over a period of 10-40 years. Because blood cannot flow well through a cirrhotic liver, blood backs up in the vessels leading to the liver. This back up of blood leads to an increase in pressure in those blood vessels, a condition known as portal hypertension Many of the signs and symptoms of cirrhosis are related to portal hypertension.
The liver has many functions, so there are a number of things that can go wrong when the liver is not functioning normally. The liver not functioning normally causes the other signs and symptoms of hepatitis C with cirrhosis.
Ascites: Portal hypertension associated with cirrhosis can cause fluid to leak from the blood vessels leading to the liver. This fluid builds up in the abdomen and is called ascites. Ascites causes the abdomen to become distended or enlarged.
Bleeding Problems: The liver produces many of the substances needed for normal blood clotting. A cirrhotic liver may not produce enough of these substances for normal clotting. If you have a cirrhotic liver and begin bleeding for any reason, it may be difficult to get the bleeding stopped.
Bone Pain: Cirrhosis can lead to a deficiency in vitamin D. This can cause softening of the bones and bone pain. This pain is most often felt in the legs, hips, and spine.
Bruising: Cirrhosis can lead to a deficiency in vitamin K. This can lead to easy bruising. If you are experiencing easy bruising, tell your health care provider because this symptom can often be reversed with appropriate treatment.
Caput Medusae: Caput medusae refers to enlarged, visible veins that start at the navel and spread out and up over the abdomen. They are caused by portal hypertension.
Gastroesophageal Varices: Gastroesophageal varices are another complication of portal hypertension. These varices are enlarged, fragile veins found where the esophagus (the tube that takes food from your mouth to your stomach) meets the stomach. These veins can burst and bleed. If you have cirrhosis and begin to vomit blood, you must call an ambulance and get to an emergency room as soon as possible to get the bleeding stopped.
Glossitis: Glossitis is a sore tongue. If you have glossitis, your tongue will be redder than usual and will be sensitive to salty and sour foods, and carbonated beverages.
Hemorrhoids: Hemorrhoids are enlarged, fragile veins found around the anus (the opening through which your bowel movements pass). Hemorrhoids can be a complication of portal hypertension. If you have hemorrhoids, they may bleed occasionally. If the bleeding persists, or is frequent, be sure to discuss it with your health care provider.
Hepatic Encephalopathy: Hepatic encephalopathy is one of the most serious complications of cirrhosis. It can occur in an acute form that develops over a period of days to weeks, or it can occur in a chronic form that develops over a period of months to years. There are a number of different symptoms that can indicate hepatic encephalopathy, but all of them indicate abnormalities of the nervous system. Early symptoms include euphoria (feeling unusually happy for no apparent reason) or depression, confusion, slurred speech, or abnormal sleeping patterns. If these symptoms are not treated, they will progress to severe confusion, incoherent speech, tremors, and rigidity. It is urgent for these symptoms to be treated or you could fall into a coma. With the acute form of hepatic encephalopathy, treatment will usually reverse all of the symptoms. However, with the chronic form, some of the symptoms may not be reversible.
Melanosis: Melanosis is a gradual darkening of those areas of skin that are exposed to the sun. The skin tends to get darker over time.
Night Blindness: Cirrhosis can lead to a deficiency in vitamin A. This can lead to episodes of night blindness. If this occurs, be certain to talk about it with your health care provider because this symptom is often reversible.
Shortness of Breath: Shortness of breath can develop as a complication of portal hypertension. Some people experience this symptom only at night; others experience it during the day as well. If you are having shortness of breath, discuss it with your health care provider who can help you with this problem.
Steatorrhea: Steatorrhea is the passing of fat in your bowel movements. The presence of fat in the stool makes the stool smell particularly bad, and causes it to float in the toilet bowl. Steatorrhea is usually accompanied by an increased amount of stool and intestinal gas.
Xanthelasma: Xanthelasmas are small deposits of fat just under the surface of the skin around your eyes. They appear as small, raised, yellowish bumps on the skin.
Xanthoma: Xanthomas are small deposits of fat just under the surface of the skin over your joints and/or tendons. They appear as small, raised, yellowish nodules.
SUMMARY: The experience of living with hepatitis C is quite different from one person to another. It is also variable for each person over time. There will probably be days when you feel great. There may be other times when you feel overwhelmed by different signs or symptoms associated with hepatitis C. And there will likely be still other times when you feel somewhere in between these two states. Below are a few things you may find helpful to keep in mind about your signs and symptoms as you learn to live with hepatitis C.
Discuss your signs and symptoms with your health care provider. There are many ways to treat the signs and symptoms associated with hepatitis C, so there is no need to suffer in silence.
Always tell your health care providers if you start to experience a new sign or symptom. Doing this will help them in their efforts to help you feel your best.
Keep all of your health care providers informed about what treatments, medicines, and supplements you are using to manage your hepatitis C. Sometimes, different treatments interact with one another in ways that cause side effects that you may experience as new signs or symptoms.
Do not panic if you start to experience new signs or symptoms. Although many of the signs and symptoms associated with hepatitis C can be troubling to you, they do not necessarily mean your liver disease is getting worse.
Frequently Asked Questions about Hepatitis C and Fatigue
Most people infected with chronic hepatitis C virus (HCV) have few symptoms or physical signs of the virus in the first two decades after infection. However, about 20 percent of those with HCV develop vague symptoms, including mild intermittent fatigue and malaise. Fatigue, which may lead to a significant decrease in quality of life, may be the first and only sign that the liver is being affected by the virus. Following are answers to some frequently asked questions about hepatitis C and fatigue.
Q. Why is fatigue associated with hepatitis C?
A. Much of the fatigue a person with HCV experiences is due to an activated immune system attempting to eliminate the virus. Despite the effective creation of antibodies against it, the hepatitis C virus can undergo frequent mutation, allowing it to avoid being eliminated from the body in 85 percent of those who contract it. In an ongoing effort to rid the body of the virus, the immune system continues to create weapons against the virus including antibodies, interleukins, and white blood cells. At times, the immune response leads to the production of immune complexes, collections of antibodies that course through the body. Immune complexes may deposit in the joints, the blood vessels in the skin, or in the kidney, leading to arthritis, rashes or glomerulonephritis (a form of kidney disease). These conditions are referred to as “extra-hepatic manifestations” of hepatitis. An immune system activated to fight a virus like HCV might also begin developing antibodies against other tissues in the body, including the thyroid. The resulting autoimmune illness, such as autoimmune thyroiditis, can result in still more symptoms of fatigue.
Q. What underlying conditions might an HCV-infected patient have that could contribute to his or her fatigue?
A. Fatigue in HCV-infected individuals is most likely due to the virus’ presence. However, a number of conditions that are readily diagnosed and treated may add to the level of fatigue. Iron deficiency anemia and hypothyroidism are both common among women and can certainly contribute to loss of energy. Depression is also common and often manifests itself as excessive sleepiness and fatigue. In fact, being diagnosed with a chronic condition can actually worsen an individual’s depression.
Q. How should conditions associated with HCV be treated?
A. In general, these conditions may be treated independently of the hepatitis. Those that are clearly related to HCV may respond to treatment with approved therapy for HCV. All medications ingested by a patient with HCV should be reviewed by his or her physician because many drugs are metabolized by the liver, which may already be compromised by the virus. Some medications, particularly some antidepressants, can lead to fatigue if serum levels are too high. Therefore, in some cases, drug dosages may need to be reduced.
Q. What changes can a person make to ease the impact of the fatigue on his or her life?
A. Most doctors recommend HCV patients eat a well-balanced diet and stop smoking. With these changes, energy levels may improve. In addition, coping with fatigue means balancing activity and rest. Some suggestions include taking short naps between activities and crafting a schedule that balances strenuous activities with ones that are less strenuous. For those with exhausting jobs, devising a flexible work schedule or telecommuting from home may be good options.
Headaches
Some people with hepatitis also complain about headaches. These headaches may go away completely after a while, but then come back. Sometimes they are mild, but at other times they are severe. They are not like migraine headaches. You can treat the headaches with over-the-counter medication. (Again, check with your doctor about what to use.) Also, take time to relax and drink plenty of fluids. Staying rested and drinking lots of fluids may prevent headaches.
Nausea and loss of appetite
Sometimes people with hepatitis have nausea and loss of appetite. You should try to eat, even if you don’t feel like it. It may help to eat many small meals rather than 3 large ones. But some patients find it is easier to eat a larger meal in the morning. Dry crackers, weak tea, ginger ale, and ice pops may be easier for you to eat than other foods. If the nausea lasts, or if you are vomiting, let your doctor know. He or she may be able to prescribe a medication to relieve the problem.
Stress and depression
Having an illness can be very stressful and sometimes downright depressing. Some of your coworkers and friends may believe false information, particularly about how the disease is spread, and this may change their attitudes toward you. You may also feel somewhat isolated because your friends and family don’t understand how you feel. You might feel tired all the time, or that you don’t have enough energy, or that no matter how much you sleep, you just don’t feel like getting out of bed. By 9 AM, you feel as if you’ve put in an entire workday. But you can get help to cope with these feelings.
Hepatitis and Depression
A diminished interest in recreational or pleasure activities or other activities that used to be enjoyable; a diminished ability to think or concentrate—indecisiveness; trouble sleeping or, alternatively, sleeping all the time; a significant weight loss or weight gain when not when not trying to lose or gain weight; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; recurrent thoughts of death or thinking about suicide; and taken together, these characteristic may cause significant distress or impairment in social, occupational, or other important areas of functioning. *These are all symptoms reported by people who suffer from hepatitis.* *They are also the clinical diagnostic criteria for Major Depression.* Many with hepatitis have said they were mistakenly diagnosed with depression when they were trying to find out what was wrong with their bodies (the “it’s all in your mind” diagnosis). There have also been those who thought they were depressed and in the process of being evaluated for medication for depression were diagnosed with hepatitis. It is however possible, and even probable, to have both: a diagnosis of Viral Hepatitis *and* a diagnosis of Clinical Depression. It can become sort of a self perpetuating downward spiral. That is, low energy, chronic fatigue, consistently not feeling well, along with the decrease in functioning that comes with these symptoms, all from hepatitis; combined with the impact of having a potentially fatal disease, are all very depressing things. An increase in depression leads to even lower energy, more decrease in functioning and even the possibility of making physical symptoms worse. Depression alone can be a serious debilitating disease. Combined with hepatitis it can be devastating. So how can you tell and what can you do? First, if you experience five or more of the symptoms above, talk to your doctor about depression. You might also want to consider seeing a therapist. Depressed or not, someone to talk to about the feelings that you experience around having hepatitis can really be a help in sorting things out sometimes. Your medical doctor or your therapist may refer you to a psychiatrist to prescribe one of the anti-depressant medications. Many of these have been shown to be very effective in treating depression. As with all medications, it is always good to be an informed consumer.
Fog (HCV Affects Cerebral Function)
Evidence for a cerebral affect of the hepatitis C virus Choline/creatine ratios are elevated in regions of the brain of patients with hepatitis C, according to research published in the latest issue of the Lancet. A team from London, England, investigated whether hepatitis C virus (HCV) affects cerebral function. Patients with HCV infection frequently complain of symptoms akin to the chronic fatigue syndrome. They also score worse on health-related quality of life indices than matched controls. The researchers used proton magnetic-resonance spectroscopy (1H MRS) to measure cerebral choline/creatine ratios in subjects. “This suggests that a biological process underlies the extrahepatic symptoms in chronic HCV infection. ” Daniel Forton. This was performed in 30 patients with histologically-defined mild chronic HCV infection, 29 age-matched and sex-matched healthy controls, and in 12 patients with chronic hepatitis B. They found that the choline/creatine ratios were significantly higher in the white matter and basal ganglia of the HCV group, compared with both the hepatitis B group and healthy volunteers. This elevation was found to be unrelated to hepatic encephalopathy or a history of intravenous drug abuse. Daniel M Forton, of Imperial College School of Medicine, St Mary’s Hospital, London, concluded on behalf of the group, “The elevation in choline/creatine ratios suggests that a biological process underlies the extrahepatic symptoms in chronic HCV infection. “These findings have implications for the direction of future research and ultimately for patient treatment.” Lancet 2001; 358: 38-9 10 July 2001
Q. What is the most common symptom of hepatitis?
A. Fatigue (severe tiredness) is the most common symptom of hepatitis.
Q. What is a good and simple exercise?
A. Walking is a good exercise that can be done regularly by almost anyone.
Q. What potentially serious condition can cause joint pain in hepatitis patients?
A. A condition known as cryoglobulinemia is sometimes the cause of joint pain in hepatitis patients. You need to talk to your doctor if you think you have this condition.
Q. What is the most important step in dealing with symptoms?
A. Your attitude, and how you take control of your life through it, can make the biggest difference in how you feel, despite this disease.
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