My understanding is that Hep C has four stages:
1. Acute - this bares no relation to the severity of the disease, but rather the 6 months following infection during which the virus takes hold.
2. Chronic - the period after six months, during which the majority of sufferers will have failed to clear the virus spontaneously. This is when the illness is considered a chronic one and it is during this stage that fibrosis will eventually start to occur.
3. Compensated cirrhosis - the point at which the chronic infection has resulted in irreversable damage to the liver. Whilst it is not possible to reverse the fibrotic changes to the hepatic architecture, the liver continues to perform its vital functions without manifesting any of the symptoms of decompensation.
4. Decompensated cirrhosis, or end-stage liver disease. The point at which the virus has caused the cirrhosis to progress to the stage that the signs of decompensation occur - i.e. HE, refactory ascites, HRS, variceal haemorrhage.
NOTE: HRS = Hepatorenal Syndrome
The four stages of cirrhosis (taken from livestrong.com)
The Merck Manuals Online Medical Libraries indicate that this stage of cirrhosis is characterized by the presence of inflammation, meaning there is swelling, an influx of inflammatory-promoting immune cells and some destruction of liver tissue. Additionally, there may also be the growth of abnormal connective tissue. These two factors, inflammation and abnormal connective tissue, are confined to the portal area of the liver. The portal area is the region surrounding the large hepatic artery, vein and bile duct. This is the area where blood and fluid flow into and out of the liver.
The second stage of cirrhosis is also characterized by inflammation, but fibrosis is also beginning to occur. The American College of Gastroenterology describes fibrosis as the replacement of normal liver tissue with scar tissue. There are no symptoms at this stage of cirrhosis because the remaining normal liver tissue is able to compensate for the non-functional scar tissue that is starting to form. However, scar tissue can never progress back into normal functioning liver tissue, meaning this transformation is permanent.
As cirrhosis progresses, the damage to the liver becomes increasingly more severe. In this stage of cirrhosis, the fibrosis forms "bridges," and is called bridging fibrosis. The Merck Manuals describe how these bridges makes abnormal connections between the hepatic artery, vein and other vessels that cause abnormal blood flow and increased blood pressure in the liver. This increased blood pressure, called hepatic hypertension, can cause even more liver damage.
Stage 4 is the most advanced stage and the growth of scar tissue has progressed to the point that the liver is not functioning normally. Whereas the previous stages are not normally associated with symptoms, advanced-stage cirrhosis has many symptoms. According to the American College of Gastroenterology, these symptoms are: bleeding in the digestive tract; jaundice, which is yellow coloring of the eyes and skin; mental effects such as confusion, unusual sleepiness and slurring of speech; the build-up of fluid in the body, medically termed edema; and intense and unexplained skin itching.
It appears to me that Stage 3 of HepC progression coincides with stage 2 of cirrhosis progression, and Stage 4 appears both in terms of HepC and Cirrhosis to be ESLD - ie. at Stage 4 they are essentially one and the same.
Post Edited By Moderator (hep93) : 6/12/2013 11:27:46 AM (GMT-6)