Autoimmune Hepatitis Flashcards
What are the 2 classes of AH?
Type 1 AIH - characteristic autoantibodies include antinuclear antibodies, anti smooth muscle antibodies, anti soluble liver antigen/liver pancreas antibodies
Type 2 AIH - characteristic autoantibodies include anti liver kidney microsomal 1 antibodies, anti liver cytosol antibodies 1
What is the aetiology of type 1 and 2 AH?
Idiopathic [4]
AIH is commonly associated with other autoimmune conditions
Type 1 AIH: Hashimoto thyroiditis, Grave disease, ulcerative colitis, celiac disease, rheumatoid arthritis
Type 2 AIH: Hashimoto thyroiditis, type 1 diabetes mellitus, vitiligo
What are the nonspecific and specific clinical features of AH?
Nonspecific symptoms
Fatigue
Upper abdominal pain
Weight loss
Signs of acute liver failure (∼ ⅓ of patients)
Jaundice
RUQ pain
Fever
Hepatomegaly
Splenomegaly
Ascites
Which diagnostic tests should be done for AH?
Laboratory tests
↑↑ ALT and ↑ AST , ↑ γGT, ↑ ALP
Serum antibodies
Type 1 AIH: ANA, ASMA, anti-SLA/LP, AMA
Type 2 AIH: anti-LKM-1, ALC-1
Serum protein electrophoresis: hypergammaglobulinemia (↑ IgG)
Normochromic anemia, thrombocytopenia, mild leukopenia, ↑ erythrocyte sedimentation rate (ESR)
Liver biopsy: Biopsy should be performed following the detection of AIH antibodies to confirm the diagnosis.
Histological findings:
Lymphoplasmacytic interface hepatitis: ongoing inflammatory process with lymphocytic infiltration, bridging or multiacinar necrosis, and fibrotic changes
Bile duct changes (e.g., cholangitis, ductal injury)
What is the d/d for AH?
Viral hepatitis (e.g., hepatitis C)
Primary sclerosing cholangitis
Primary biliary cirrhosis
Alcoholic liver disease
Nonalcoholic steatohepatitis
Drug-induced liver injury
Drug-induced autoimmune-like hepatitis (DIAH)
Hemochromatosis
What is the treatment for AH?
Immunosuppressive medications
Induction therapy
First-line: prednisone with or without azathioprine
Second-line: mycophenolate, cyclosporine, tacrolimus
Maintenance therapy: low doses of azathioprine or prednisone
Liver cirrhosis - Liver transplantation is indicated in cases of decompensated liver cirrhosis.
What is the prognosis for AH?
10 year survival rate with treatment - 90%
