Autoimmune Hepatitis Flashcards
What is autoimmune hepatitis (AIH)?
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.
Briefly descibre the aetiology of AIH
- Genetic predisposition
- Environmental triggers (e.g. drugs, viral infections or herbal agents)
- Auto-antigens
- Dysfunction of immunoregulatory mechanisms
What are the risk factors for AIH?
- Female gender
- Genetic predisposition
- Immune dysregulation
What are the signs of AIH?
- Hepatosplenomegaly
- Jaundice
What are the symptoms of AIH?
- Fatigue and malasie
- Anorexia
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What investigations should be ordered for AIH?
- AST level
- ALT level
- Bilirubin
- Gamma glutamyl transferase (Gamma-GT)
- Alkaline phosphatase
- Serum globulin
- Serum albumin
- Prothrombin time
Why investigate AST? And what may this show?
- Indicator of inflammatory activity in the liver. Raised in 100% of patients with AIH at initial presentation.
- Raised in other liver diseases. Not specific to liver disease.
Why investigate ALT? And what may this show?
- Indicator of inflammatory activity in the liver. Raised in 100% of patients with AIH at initial presentation.
- Raised in other liver diseases. Not specific to liver disease.
Why investigate bilirubin? And what may this show?
- Increased in 80% to 90% of patients with AIH
- Mild to moderately increased
Why investigate gamma-GT? And what may this show?
- Mild to moderately increased
Why investigate alkaline phosphatase? And what may this show?
- Mild to moderately increased
Briefly describe the treatment for AIH
Corticosteroids (e.g. prednisolone) and immunosuppressants (e.g. azathioprine) form the mainstay of treatment.
Give examples of patients in which corticosteroids should be used with caution
Patients with:
- Cirrhosis
- Post-menopausal osteopenia or vertebral compression
- Emotional lability or psychosis
- Poorly controlled hypertension
- Brittle diabetes are at increased risk of adverse effects with corticosteroids
When is liver transplantation considered in AIH?
Indicated in patients who deteriorate during or after corticosteroid treatment and in patients who are refractory to or intolerant of standard treatment and in whom end-stage liver disease develops.
What complications are associated with AIH?
- Osteoporosis due to corticosteoid therapy
- Diabetes mellitus due to corticosteroid therapy
- Hypertension due to corticosteroid therapy
- Truncal obesity due to corticosteroid therapy
