Autoimmune Hepatitis

Question 1

what is autoimmune hepatitis?

Answer 1

inflammation of the liver due to autoantibodies (nonviral)

Question 2

what is the pathophys for autoimmune hepatitis?

Answer 2

genetic suspectibility + environmental trigger/drug ➔ inappropriate immune reaction ➔ self-reactive T cells not destroyed in the thymus ➔ antibodies vs hepatocytes created ➔ inflammation ➔ damage

Question 3

What is the difference in epidemiology in type 1 and type 2 autoimmune hepatitis??

Answer 3

type 1 - older women 40-50s and often post menopausal

type 2 - children and younger adults, usually female

Question 4

How does autoimmune hepatitis usually present?

Answer 4

Can range from asymptomatic to full liver failure
Common s/s are fatigue, malaise, jaundice, abdo pain, and arthralgias

Question 5

Type 2 autoimmune hepatitis patients often also have ____ comorbidities. Name some examples

Answer 5

autoimmune diseases

hashimoto thyroiditis
Graves disease
Crohn’s
Ulcerative colitis
Celiac

Question 6

What factors contribute to developing autoimmune hepatitis?

Answer 6

genetic risk factors - HLA
history of autoimmune disease
environmental trigger or drugs

Question 7

how would you diagnose someone with autoimmune hepatitis?

Answer 7

this is a diagnosis of exclusion, should work up for viral hepatitis first

1. w/u for viral hepatitis
2. ALT/AST (elevated) and ALP and GGT (normal)
3. albumin (may be decreased, if liver synthesis function is poor)
4. PT/INR (may be prolonged, if liver synthesis function is poor)
5. bilirubin (elevated)
6. serum globulin (markedly increased)
7. require a biopsy to establish the diagnosis ➔ interface hepatitis and plasma cell infiltration

could consider specific antibody testing
Type 1: antinuclear antibodies (ANA), and anti smooth muscle antibodies (ASMA) (both are non-specific), specific test for AIH is Anti-soluble liver antigen (anti-SLA/LP)
Type 2: anti-liver kidney microsome 1 antibodies (anti-LKM1) and anti-liver cytosol antigen type 1 (anti-LC1) (specific for AIH2)

Question 8

How to you treat autoimmune hepatitis?

Answer 8

1. refer to GI - hepatologist
2. immunosuppressants + corticosteroids
3. consider liver transplant, however the autoimmune rxn can damage the new liver
4. regular follow up
5. pt education, avoid alcochol, unregulated herbal supplements, and high dietary fats