Autoimmune hepatitis

Question 1

Define

Answer 1

Chronic hepatitis of unknown aetiology, characterised by autoimmune features, hyperglobulinaemia and the presence of circulating autoantibodies

Question 2

Aetiology/risk factors

Answer 2

lymphoid infiltration of the portal tracts and hepatocyte necrosis, leading to fibrosis and, eventually, cirrhosis

o	Type 1 (more common)
•	ANA
•	ASMA
•	Anti-actin antibodies (AAA)
•	Anti-soluble liver antigen (anti-SLA)
o	Type 2
•	Antibodies to liver/kidney microsomes (ALKM-1)
•	Antibodies to liver cytosol antigen (ALC-1)

Question 3

Epidemiology

Answer 3

more common in women.

Type 1 in all ages
Type 2 - occurs in young women and girls

Question 4

Symptoms

Answer 4

May be asymp

Jaundice
Malaise
weight loss
nausea
anorexia 
ammenorhea 
epitaxsis 

Acute hepatitis:

• Vomiting
• jaundice
• fever
• ruq pain
• maculopapular rash

Question 5

Signs

Answer 5

STIGMATA OF CHRONIC LIVER DISEASE e.g. ascites, spider naevi etc

Cushingoid appearance even before steroids.

Question 6

investigations

Answer 6

LFT’s
FBC - hyperglobinaemia check.
Liver biopsy

Rule out other causes - Urinary copper (wilson’s), ERCP (PSC), ferritin (hameochromatsis), viral serology (viral hep a and b) and a1-antitrypsin

Question 7

management

Answer 7

Does not always require management.

1st steroids - prednisolone
2nd - maintenance - steroid sparing drugs such as Azathioprine
3rd- monitor (US and a1-antitrypsin every 6-12 month and liver biopsy)
4th- Hep A and b vaccine

Liver transplant if all else fails

Question 8

complications

Answer 8

HCC
Fulminant hepatic failure
cirrhosis 
side effects of steroids 
portal hypertension - oesophageal varices and ascites

Question 9

prognosis

Answer 9

if treated 5 year prognosis is 85% if not 50% with the transplant >80%.

The elderly are more likely to present with cirrhosis but will respond better to treatment.