Hepatitis C: Diagnosis And Course

Hepatitis C: Diagnosis & Course

Acute hepatitis C can develop within about six months of being infected with the hepatitis C virus. If the person's immune system cannot clear the virus within six months, chronic hepatitis C infection will develop. Acute and initially chronic hepatitis C often cause no symptoms or only atypical symptoms such as tiredness, poor performance or poor concentration.

Other possible complaints are loss of appetite and nausea, right-sided upper abdominal pain, jaundice, joint problems and itching. Complications from hepatitis C can cause a variety of symptoms. The progression of the disease and the development of consequential damage depend on various factors. The course of a hepatitis C infection can therefore be very different.

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• What is the course of acute hepatitis C?
• How does chronic hepatitis C work?
• How is the diagnosis made?
• ">Whom can I ask?

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• How will the costs be reimbursed?

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What is the course of acute hepatitis C?

Acute hepatitis C can develop two to 26 weeks after infection. The majority of those affected (approx. 75 percent) show no symptoms or only unspecific symptoms, so that the infection can go completely unnoticed. In about 25 percent of infections, there are usually very mild symptoms of hepatitis. These include loss of appetite, nausea, pain in the right upper abdomen, a slight fever and possibly the development of jaundice (jaundice). The disease heals by itself in 15 to 40 percent of those infected. The age of the person affected at the time of infection has an influence on the course. In children and young adults, spontaneous healing occurs more frequently in the acute phase of the disease than in older people. Fulminant courses with acute liver failure are extremely rare.

How does chronic hepatitis C work?

In 60 to 80 percent of people, the immune system cannot clear the virus and chronic hepatitis C infection develops. With a chronic infection, the hepatitis C viruses constantly infect new liver cells and die. The dead liver cells are replaced by connective tissue (scar tissue). If the liver is changed like connective tissue, one speaks of liver fibrosis - later of liver cirrhosis. Liver cirrhosis develops - if there are no other factors damaging the liver - at the earliest 20 years after the infection. At this stage the structure of the liver is already permanently disturbed.

The following risk factors are associated with an aggressive course of the disease:

• Long-term alcohol consumption
• male gender,
• older age at the onset of the disease,
• additional HIV or HBV infection (co-infection),
• an infection with genotype 3,
• long-term blood washing (hemodialysis),
• genetic factors,
• severe overweight (obesity) as well
• Diabetes mellitus.

Note Alcohol has an accelerating effect! Basically: A daily alcohol consumption of more than 20 grams for women - corresponds to about half a liter of beer or a quarter of a liter of wine or 40 grams for men damages the liver. However, this is a rough indication. Alcohol tolerance varies greatly from person to person and depends on many factors. Numerous studies show that the amount of alcohol and the course of the illness are closely related. The damaging process of chronic hepatitis C infection, which is otherwise very slow, is greatly accelerated, and the development of cirrhosis of the liver progresses faster.

As long as the remaining healthy liver tissue is able to perform most of the liver's tasks, there are no or only few symptoms of the disease (compensated cirrhosis of the liver).

Typical signs of a decompensation of liver cirrhosis are the formation of ascites (ascites) and the development of jaundice (jaundice). In addition, there is a tendency to bleeding due to coagulation disorders because the liver is no longer able to provide certain coagulation factors in sufficient quantities. The development of a lack of blood platelets (thrombocytopenia) also increases the risk of bleeding. The risk for is significantly increased.

Due to the connective tissue remodeling of the liver, the blood can flow increasingly poorly through the organ. This back pressure of the blood increases the blood pressure in a large vein (portal vein) that leads to the liver (portal hypertension). Free water forms in the abdomen (ascites) and varicose veins form in the esophagus (esophageal varices) and in the stomach, which are prone to dangerous bleeding. If the liver can no longer fulfill its function as a detoxification organ, disorders of the brain function (hepatic encephalopathy) can occur. Those affected suffer from changes in their level of consciousness, intellectual performance, behavior and movement sequences.

Chronic hepatitis C can also affect "outside" the liver, particularly in the form of autoimmune diseases (eg vascular inflammation that can damage the kidneys, skin or thyroid). Diabetes mellitus is more likely to develop. In addition, various cancers - e.g. non-Hodgkin lymphoma, pancreatic (pancreatic carcinoma) and lung cancer (bronchial carcinoma) - occur more frequently in patients with chronic hepatitis C. Various brain functions can be affected even in the absence of hepatic encephalopathy. Many people infected with hepatitis C report frequent fatigue and difficulty concentrating or suffer from depression.

How is the diagnosis made?

During the physical exam, the doctor can often feel an enlarged liver that may be tender on pressure. When cirrhosis of the liver has developed, the liver becomes smaller and firmer and is often no longer palpable. In addition, she / he may be able to recognize other signs of liver disease such as jaundice, ascites or typical skin changes (spider-shaped spider veins or a lack of abdominal hair). Hepatitis C can only be diagnosed by certain blood tests:

Laboratory diagnostics

The liver values: bilirubin, GOT and GPT are usually moderately to significantly increased, but normal liver values do not rule out hepatitis C.

The following laboratory values are carried out when diagnosing hepatitis C:

• Antibodies (HCV antibodies) can only be detected positive by means of an ELISA test after six to twelve weeks,
• direct detection of the hepatitis C virus RNA (qualitative PCR test),
• Determination of viral load (quantitative PCR test) - indicates the amount of virus.

Further examinations after a hepatitis C diagnosis

If hepatitis C is diagnosed, additional blood tests will be done. These include GOT, GPT, GGT, blood count and coagulation values (Quick / INR).

An abdominal ultrasound and an examination for possible liver cirrhosis by means of a biopsy or a special ultrasound examination (elastography) are also carried out.

Before hepatitis C therapy, the genotype (genotypes 1-7 - "virus groups" with small deviations in the genetic material) including the subtype (eg genotype 1a) is determined under certain circumstances. The genotypes influence the choice of drugs to treat hepatitis C.

It is also checked whether the person affected is also infected with hepatitis B. Hepatitis C viruses suppress the reproduction of the hepatitis B viruses. Hepatitis C therapy can therefore lead to severe liver inflammation in individual cases without treatment for hepatitis B. Regular hepatitis B check-ups must also be carried out in patients who have previously had hepatitis B. The hepatitis C therapy can occasionally reactivate the hepatitis B viruses.

Whom can I ask?

The general practitioner can issue referrals to a laboratory or for an ultrasound examination if an inflammatory liver disease is suspected. In addition, she / he arranges for care by a specialist in internal medicine (preferably specializing in gastroenterology and hepatology).

The diagnosis of hepatitis C is also possible in the following facilities:

• special hospital outpatient department, e.g. hepatological outpatient department,
• Cash outpatient clinics with special hepatology clinics,
• In the private practice area: Specialists in internal medicine with sound hepatological knowledge,
• Patients with severe forms of illness are cared for in a department for internal medicine (focus on gastroenterology and hepatology).

How will the costs be reimbursed?

All necessary and appropriate diagnostic measures are taken over by the health insurance carriers.

Your resident doctor or outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see Visit a Doctor: Costs and Deductibles.

For more information about the respective provisions, please contact your health insurance provider, which you can find on the social security website, for example.