3.12. Liver + Biliary Tree Disease - Autoimmune Hepatitis Flashcards
What is the Aetiology of Autoimmune Hepatitis?
It is unknown
Is Autoimmune Hepatitis more common in Males or Females?
Females
What can Autoimmune Hepatitis be related to?
Other autoimmune conditions
What is required for Autoimmune Hepatitis to occur?
- A Genetically Predisposed Host
2. An External Environmental Factor
What is the Pathology of Autoimmune Hepatitis?
The Environmental Factor causes a sequence of T-Cell mediated events against Liver Antigens
What is an example of what the Environmental Factor could be?
A Virus
What do the T-Cell mediated events against the Liver result in?
A Necroinflammatory response
When are the 2 peak onsets for women with Autoimmune Hepatitis?
- Peri-menopausal
2. Post-menopausal
What is the Clinical Presentation of Autoimmune Hepatitis?
- Asymptomatic
- Fatigue
- Acute Hepatitis
- Jaundice
- High Aminotransferase Levels (AST and ALT)
- Hepatmegaly
- Splenomegaly
- Flu-like Symptoms
When can Autoimmune Hepatitis appear Asymptomatic until?
- The Liver becomes Cirrhotic
2. There is an Abnormality in the Liver Biochemistry
When does Acute Hepatitis occur as a result of Autoimmune Hepatitis?
In the Young
What type of Jaundice occurs?
Intrahepatic Jaundice
Do the High Aminotransferase Levels (AST and ALT) improve over time?
No
Why does Hepatomegaly occur?
Due to the Necroinflammatory Response within the Liver
Why does Splenomegaly occur?
Due to the Backlog of Blood Pressure (Portal Hypertension) from the Liver
What Flu-like Symptoms can a patient present with? And why?
Fever, Malaise, Rigors, Sweating - Due to the internal damage of the Liver
What investigations are Required in Autoimmune Hepatitis?
- Liver Function Test (and Biochemistry)
- Haematological Investigation
- Auto-antibody Investigation
- Biopsy
What is Tested in a Liver Function Test (and Biochemistry)?
Liver Function Test:
- Serum Albumin
- Prothrombin Time
Liver Biochemistry:
- Bilirubin
- Alkaline Phosphatase
- Gamma-Glutamyl Transpeptidase
- Aminotransferases:
a) Aspartate Aminotransferase
b) Alanine Aminotransferase
What would be seen in a Liver Function Test (and Biochemistry) of a patient with Autoimmune Hepatitis?
- High Serum Aminotransferases
- Elevations in Serum Bilirubin and Alkaline Phosphatase
- High Gamma-Glutamyl Transpeptidase
- High Prothrombin Time
What is the Haematological Investigation looking for?
Mild Normochromic, Normocytic Anaemia, with Thrombocytopenia and Leukopenia
What are the 2 Types of Auto-antibody which can cause Autoimmune Hepatitis?
- Type 1
2. Type 2
What do Type 1 Auto-antibody’s consist of?
- Anti-Nuclear Antibodies (ANA)
- Anti-Smooth Muscle Antibodies (Actin)
- Anti-Soluble Liver Antigen (Anti-SLA)
What do Type 2 Auto-antibody’s consist of?
Anti-Liver/Kidney Microsomal (Anti-LKM-1)
What is the purpose of the Biopsy?
To see how far the Changes of Autoimmune Hepatitis have occurred
What type of drugs are used to treat Autoimmune Hepatitis?
Steroids (Immunosuppression)
Which Drugs are used in the Treatment of Autoimmune Hepatitis?
- Prednisolone
- Budesonide
- Azathioprine
What type of Drug is Azathioprin?
A Steroid Sparing Agent
When can Cirrhosis occur due to Autoimmune Hepatitis?
At a late stage
