Autoimmune Hepatitis

Question 1

What is autoimmune hepatitis.

Answer 1

It consists of periportal piecemeal necrosis/bridging necrosis, and fibrosis.

It is a disease of immune-mediated liver injury characterized by the presence of serum antibodies and peripheral blood T lymphocytes reactive with self-proteins.
It has a strong association with other autoimmune diseases.

Question 2

What is the serum immunoglobulin most commonly raised in autoimmune hepatitis.

Answer 2

IgG.

Question 3

Who is autoimmune hepatitis seen in.

Answer 3

Most commonly seen in women.
However, it can occur in any sex at any age.
Acute presentations usually occur in teens - 30s.
Chronic presentations can occur at any point, but are more common in women over 40.

Question 4

What are the symptoms of autoimmune hepatitis. (9)

Answer 4

The onset of symptoms is usually insidious:
Fatigue.
Abdominal discomfort. 
Decreased appetite. 
Myalgia.
Jaundice. 

In about 1/4 of patients, the onset is acute:
Fever. 
Arthralgia. 
Vitiligo.
Epistaxis. 
Amenorrhoea can occur.

Question 5

What are the signs of autoimmune hepatitis. (3)

Answer 5

Hepatomegaly.
Icterus.
Signs of chronic liver disease/cirrhosis.
Jaundice is mild to moderate.
Associated autoimmune disease (eg Hashimoto’s thyroiditis or rheumatoid arthritis) may be present in acute presentations.
Other signs of autoimmune disease are present in acute presentations:
Urticarial rash.
Polyarthritis.
Pleurisy,
Pulmonary infiltrations.
Glomerulonephritis.

Question 6

What conditions are associated with autoimmune hepatitis. (12)

Answer 6

Migrating polyarthritis. 
Urticarial rashes. 
Lymphadenopathy. 
Hashimoto's thyroiditis. 
Thyrotoxicosis. 
Myxoedema. 
Pleurisy. 
Coombs-positive haemolytic anaemia.
Transient pulmonary infiltrates. 
Ulcerative colitis. 
Glomerulonephritis. 
Nephrotic syndrome.