Autoimmune Hepatitis

Question 1

Autoimmune hepatitis presentation

Answer 1

• insidious onset 1/3
• sxs of acute hepatitis (40%)
• jaundice, dark urine
• hepatomegaly, splenomegaly on exam
• ascites
• portal hypertension.

Question 2

Autoimmune hepatitis characteristics

Answer 2

• progressive inflammatory disease
• elevation in bilirubin and transaminases (transaminases are more elevated than GGT)
• positive autoantibodies
• positive histologic features

Question 3

Extrahepatic autoimmune associations of AIH.

Answer 3

Arthritis
Thyroid disease
Juvenile onset diabetes

Question 4

Extrahepatic autoimmune risk factors of AIH.

Answer 4

Celiac
IBD
SLE
Immune dysregulation
Minocycline.

Question 5

Autoimmune Hepatitis Type 1 lab findings

Answer 5

+ SMA
+ ANA
+ HLA DR3, HLADR4
+older onset, acute hepatitis, cirrhosis

Question 6

Autoimmune Hepatitis Type 2 lab findings

Answer 6

+ LKM
+ LC1
+ HLA DR7, HLA DR3
Younger onset, acute hepatitis, liver failure.

Question 7

Extrahepatic diseases associated with AIH type 1

Answer 7

UC
PSC (overlap)
Vasculitis
Arthritis
ITP
Hemolytic anemia
Glomerulonephritis

Question 8

Extrahepatic diseases associated with AIH type 2.

Answer 8

Polyendocrinopathy
Vitiligo
Alopecia areata
Thyroiditis
Diabetes
Nail dystrophy

Question 9

AIH clinical features

Answer 9

Hepatomegaly
Splenomegaly
Jaundice
Ascites (20%)

Question 10

AIH Histopathology (SC excluded)

Answer 10

Interface hepatitis, lymphoplasmacytic infiltrate, resetting of HCs.
Biliary proliferation, fibrosis, cirrhosis (20%).
Periportal necrosis +/- bridging necrosis. 10-20-% have giant cells.
Intralobular degeneration and focal necrosis.

Question 11

AIH treatment

Answer 11

Steroids
Imuran
Mycophenolate.
Tacro
Ursodiol
Transplantation.