Hepatitis

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 ("liver pain")
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