Autoimmune hepatitis

Question 1

clinical features of autoimmune hepatitis:

Answer 1

asymptomatic, non specific symptoms of fatigue and nausea

see small joint arthralgias of hands

see other autoimmune disease (hemolytic anemia, ITP, DM1)

can present with acute liver failure

Question 2

diagnosis of autoimmune hepatitis

Answer 2

elevated bilirubin, transaminases,

immunoglobulin IgG

positive serological markers ANA, anti smooth muscle, LKM-1, LC-1

liver biopsy - shows piecemeal necrosis abscess of other liver dx (viral hepatitis

Question 3

treatment of autoimmune hepatitis

Answer 3

steroids + azathioprine or 6 mercaptopurine

liver transplant or ALF or decompensated cirrhosis

Question 4

autoimmune hepatitis is seen in

Answer 4

women 40-50

auto antibodies against liver can present with acute liver failure

see coexisting autoimmune disorders: DM1, thyroiditis, celiac sprue, or UC

Question 5

antibodies associated with autoimmune hepatitis

Answer 5

ANA

anti smooth muscle antibody ASMA

anti-liver kidney microsomal antibody (LKM-1)

liver cytosol antibody LC-1

Question 6

diagnosis of autoimmune hepatitis is based on:

Answer 6

clinical presentation serological markers exclusion of other forms of chronic liver dx

Question 7

autoimmune hepatitis is characteriszed by:

Answer 7

gradual hepatocyte damage and nonspecific symptoms see persistently elevated LFTs (predominantly ALT) and see circulating autoantibodies.

Question 8

when to screen pt for autoimmune hepatitis?

Answer 8

transaminases >10 x normal transaminases >5 x normal wiht hyperglobulinemia evidence of necrosis on liver biopsy incapacitating symptoms

Question 9

treatment of autoimmune hepatitis:

Answer 9

prednisone is preferred therapy then combine for azathioprine for lower steroid dose and fewer adverse effects

steroids then azathioprine leads to improvement in 90% of pts and 10-40% getting sustained remission but some pts develop cirrhosis and need liver transplant.

Question 10

if patient with autoimmune hepatitis cannot tolerate steroids and azathioprine what next?

Answer 10

can try with a calcineurin inhibitor: tacrolimus and cyclosporine) or other immunosuppressives like sirolimus methotrexate and mycophenolate mofetil.

Question 11

autoimmune hepatitis can have this on labs:

Answer 11

see hypergammaglobulinemia