Autoimmune Hepatitis Flashcards
Define autoimmune hepatitis.
Autoimmune hepatitis (AIH) is a chronic inflammatory disease of the liver of unknown aetiology. It is characterised by the presence of circulating auto-antibodies with a high serum globulin concentration, inflammatory changes on liver histology, and a favourable response to immunosuppressive treatment.
Explain the aetiology/risk factors of autoimmune hepatitis.
Female gender
Genetic predisposition
Immune dysregulation
Summarise the epidemiology of autoimmune hepatitis.
All ethnicities are susceptible to the disease, but prevalence is greatest among people with northern European ancestry who have a high frequency of human leukocyte antigen (HLA)-DR3 and HLA-DR4 markers.
Recognise the presenting symptoms of autoimmune hepatitis. Recognise the signs of autoimmune hepatitis on physical examination.
Fatigue/malaise
Anorexia
Abdominal discomfort
Hepatomegaly
Jaundice
Pruritus
Arthralgia
Nausea
Fever
Spider angiomata
Splenomegaly
Identify appropriate investigations for autoimmune hepatitis and interpret the results.
Aspartate transaminase
Alanine transaminase
Bilirubin
Gamma-GT
Alkaline phosphatase
Serum globulin
Serum albumin
Prothrombin time
Generate a management plan for autoimmune hepatitis.
Observation and monitoring
Corticosteroid monotherapy e.g. prednisolone
Identify the possible complications of autoimmune hepatitis and its management.
Osteoporosis, diabetes mellitus, hypertension, truncal obesity, cataracts due to corticosteroid therapy.
Hepatocellular carcinoma, end-stage liver disease due to progression of AIH.
Bone marrow suppression, cholestatic hepatitis, pancreatitis, skin rash due to azathioprine therapy.
Summarise the prognosis for patients with autoimmune hepatitis.
The natural history of AIH reveals that untreated AIH has a poor prognosis with a 5-year survival rate of 50% and 10-year survival rate of 10%. Immunosuppressive therapy significantly improves survival.
