Autoimmune Hepatitis

Question 1

Definition

Answer 1

Rare, chronic autoimmune liver disease which can progress to cirrhosis

Question 2

Antibodies associated with T1 AIH

Answer 2

Type 1 autoantibodies:
-Anti-nuclear antibodies (ANA)
-Anti-smooth muscle antibodies (ASMA)
-Anti soluble liver antigen (anti-SLA/LP)

Question 3

Antibodies associated with T2 AIH

Answer 3

Type 2 autoantibodies:
- Anti-liver kidney microsomes-1 (anti-LICM1)
- Anti-liver cytosol antigens type 1 (anti-LC1)

Question 4

Epidemiology

Answer 4

FEMALE
Age:
- Type 1 AIH = Adults
- Type 2 AIH = Children

Question 5

Risk factors

Answer 5

HLA association:
- Type 1 AIH = HLA DR3, DR4
- Type 2 AIH = HLA DQB1, DRB1

Question 6

Aetiology

Answer 6

Unclear and seems to be due to an interplay between environmental and genetic factors

Question 7

Signs

Answer 7

Evidence of chronic liver disease:
- Jaundice
- Spider telangiectasia
- Gynaecomastia
- Splenomegaly
Evidence of acute liver failure:
- Jaundice
- Ascites
- Variceal bleed
- Encephalopathy

Question 8

Symptoms

Answer 8

Fatigue
Arthralgia
Weight loss
Nausea
Amenorrhoea

Question 9

Diagnosis

Answer 9

LFTs: elevated ALT and AST with normal or mildly elevated ALP. Bilirubin may also be raised
Immunoglobulins: IgG
Liver biopsy: inflammation of hepatocytes at the junction of the portal tract and hepatic parenchyma = piecemeal necrosis
Viral screen
Autoimmune screen: ANA, anti-SMA. Anti-SLA/LP, anti-LKM1, Anti-LC1

Question 10

Management

Answer 10

FIRST LINE:
Immunosuppression: PREDNISOLONE and AZANTHIOPRINE
SECOND LINE: Transplantation

Question 11

Complication

Answer 11

Cirrhosis
Osteoporosis
Cushing’s
Hepatocellular