“Inflammation of the liver caused by an infection with the Hepatitis C virus”

Risk Factors
  • IV drug users
  • People receiving blood regularly (haemophilia)
  • Healthcare workers (needlestick injuries)
  • Haemodialysis and chronic renal failure
  • Mother-baby transmission
  • Tattoos, body piercings, or acupuncture with non-sterile equipment
  • People with HIV
  • Risk factors for progression to chronic hepatitis:
    • Male
    • Increasing age
    • Chronic alcohol
    • HIV
    • Previous hepatitis B infection
Aetiology
  • RNA virus
  • Spread via blood: sexual contact, IV drug abuse, transfusions
  • Highly infectious
  • Causes both acute and chronic infection
Pathophysiology
  1. Virus enters the body
  2. Replicates in hepatocytes
  3. Interferes with cell function
  4. Causes inflammation of the liver
Clinical Presentation
  • Symptoms:
    • Abdominal discomfort
    • Nausea
    • Anorexia
    • Arthralgia
    • Dark urine, pale stool
    • Pruritus
  • Signs:
    • Fever
    • Jaundice
    • RUQ tenderness
    • Hepatomegaly
  • Chronic Infection:
    • Signs of chronic liver disease
    • Jaundice
    • Hepatosplenomegaly
    • Spider naevi
    • Severe cases: ascites, liver flap, encephalopathy
Investigations
  • LFTs
  • FBC
  • U&Es
  • HbA1c
  • Prothrombin time
  • Tests for hepatitis A and B
Management
  • Notify the Health Protection Unit
  • Urgent referral if chronic infection
  • Requires specialist management
  • Conservative:
    • Avoid unprotected sexual intercourse
    • Quit alcohol
    • Avoid sharing needles
  • Medical:
    • Analgesia (paracetamol, weak opioid if liver impairment mild)
    • Chlorphenamine for itch
    • Direct-acting antivirals
  • Surgical:
    • N/A
  • Consider referral to GUM clinic or drug rehabilitation services
  • Vaccination
Complications
  • Can develop into chronic hepatitis (85% silent chronic infection)
  • Glomerulonephritis
  • Autoimmune hepatitis
  • Liver cirrhosis
  • Hepatocellular carcinoma

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