Autoimmune Hepatitis Flashcards
Define autoimmune hepatitis
a chronic inflammatory disease of the liver of unknown aetiology - 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.
What are the antibodies involved in autoimmune hepatitis?
Type 1: ANA (anti-nuclear antibody), SMA (smooth muscle antibody), p-ANCA (perinuclear
anti-neutrophil cytoplasmic autoantibody), anti-SLA/LP (soluble liver antigen)
Type 2: anti-LKM1 (anti-liver kidney microsomal-1)
What are the causes/risk factors of autoimmune hepatitis?
Unknown aetiology
Characterised by hypergammaglobulinaemia with high IgG levels, presence of circulating
autoantibodies and inflammatory changes on histology
• Female preponderance
• HLA-DR3/DR4
• Associated with other autoimmune conditions e.g. pernicious anaemia, thyroiditis
and coeliac disease
What are the symptoms of autoimmune hepatitis?
- Fatigue/malaise
- Anorexia
- Abdominal discomfort
- Nausea
- Fever
What are the signs of autoimmune hepatitis?
Signs of chronic liver disease • Hepatomegaly • Jaundice • Spider naevi • Encephalopathy
What investigations are carried out for autoimmune hepatitis?
raised: • aspartate transaminase • alanine transaminase • bilirubin • gamma-GT • alkaline phosphatase • serum globulin • prothrombin time
decreased:
• serum albumin
test for antibodies:
• anti-nuclear antibodies (ANAs)
• smooth muscle antibodies (SMAs)
• anti-soluble liver antigens or liver/pancreas (anti-SLA/LP)
• perinuclear anti-neutrophil cytoplasmic antibodies (pANCA)
• antibodies against single-stranded DNA (anti-ssDNA)
• antibodies against double-stranded DNA (anti-dsDNA antibodies)
• antibodies to liver/kidney microsome type 1 antigen (anti-LKM-1 antibodies)
• antibodies to liver/kidney microsome type 3 antigen (anti-LKM-3)
• antibodies to liver cytosol 1 antigen (anti-LC1)
• anti-mitochondrial antibodies (AMAs)
