Autoimmune hepatitis

Question 1

Who is this most commonly seen in?

Answer 1

Young females

Question 2

Associated with?

Answer 2

Other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3

Question 3

How many types of autoimmune hepatitis are there and how are they classified?

Answer 3

Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present

Question 4

Type 1 antibody and who does it affect?

Answer 4

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Affects both adults and children

Question 5

Type 2 antibody and who does it affect?

Answer 5

Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Affects children only

Question 6

Type 3 antibody and who does it affect?

Answer 6

Soluble liver-kidney antigen

Affects adults in middle-age

Question 7

What can be seen on liver biopsy?

Answer 7

Inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis

Question 8

Features?

Answer 8

• may present with signs of chronic liver disease
• acute hepatitis: fever, jaundice etc (only 25% present in this way)
• amenorrhoea (common)
• ANA/SMA/LKM1 antibodies, raised IgG levels

Question 9

Management?

Answer 9

• steroids, other immunosuppressants e.g. azathioprine

- liver transplantation