Autoimmune Hepatitis

Question 1

What are the clinical presentation of autoimmune hepatitis?

Answer 1

1. Middle age women, premenopause
   (females > males 3:1)
2. Acute hepatitis with autoimmune symptoms 0 fatigue, arthralgia, myalgia
3. Chronic hepatitis
4. Incidental findings of chronic liver disease through LFT or associated autoimmune disease

Question 2

What are the autoimmune conditions associated with autoimmune hepatitis?

Answer 2

1. RA
2. Thyroiditis
3. IBD
4. Pernicious anaemia
5. IDDM
6. AIHA
7. PSC > PBC

Question 3

What are the investigations for autoimmune hepatitis?

Answer 3

1. Autoantibodies
   - Type 1: ANA, anti-SMA, HLA B8, HLA DRw3
   - Type 2: anti-LKM1
2. FBC - mono-pancytopenia
3. LFT - raised ALT, AST > 5x ULT
4. IgG raised (in PBC IgM is raised)
5. Viral hepatitis panel - negative
6. Liver biopsy
   - Mononuclear infiltrates ofp ortal and periportal areas, piecemeal necrosis -> fibrosis -> cirrhosis

Question 4

What are the treatment for AIH?

Answer 4

1. Immunosuppression - prednisolone, azathioprine
2. Liver transplant

Question 5

What is the prognosis of untreated severe AIH?

Answer 5

40% survivors develop cirrhosis
40% mortality in 6 months