Autoimmune hepatitis

Question 1

What is autoimmune hepatitis?

Answer 1

Autoimmune hepatitis is usually seen in young and middle-aged women. It is commonly associated with other autoimmune disorders, hence one clue here is the woman’s past history of Grave’s disease.

Question 2

What are clinical features of autoimmune hepatitis?

Answer 2

Jaundice
Fatigue
Loss of appetite
Hepatomegaly
Splenomegaly
Abdominal pain

Question 3

What would liver function tests for autoimmune hepatitis show?

Answer 3

Liver function tests are usually deranged and indicate a hepatic pattern of disease. Raised ALT and bilirubin with normal/mildly raised ALP. Patients may have an IgG predominant hypergammaglobulinemia.

Question 4

What are the three different types of autoimmune hepatitis?

Answer 4

Type 1 - The commonest type. These patients have raised levels of anti-smooth muscle antibodies (80%), and antinuclear antibodies may also be positive (10%).

Type II - Less common but often more severe; anti liver/kidney microsomal antibodies type 1 tend to be positive.

Type III - Also less common, and often positive for anti-soluble liver antigen.

Type II and III AIH are negative for anti-smooth muscle antibodies and antinuclear antibodies.