autoimmune hepititis Flashcards
definition
CHRONIC
- inflammatory disease
- classified into 3 types
epidemiology
young
middle-aged
women
other associated immune disorders
associated immune disorders
- pernicious + haemolytic anaemia
- ulcerative cholitis
- Hashimoto’s / graves
- primary sclerosing cholitis
aetiology
- abnormal autoimmune reaction against hepatocyte surface antigens
- HLA-B8 + DR3 most commonly effected
3 types of autoimmune hepatitis
type 1:
- ANA positive
- anti-smooth muscle antibodies
type 2:
- anti-liver/kidney mitochondrial type 1 antibodies - can be remembered as little kids (liver/kidney) + children predominantly get this
type 3:
- antibodies directed against soluble liver-kidney antigen
signs and symptoms
acute
chronic
other
- fatigue
- anorexia
- hepatomegaly
- splenomegaly
blood test findings
general:
- high ALT + AST (X10)
- high bilirubin
- mildly raised ALP
- IgG predominant hypergammaglobinaemia (2X normal)
type 1:
- raised anti-smooth muscle antibodies (80%)
- positive antinuclear antibodies (10%)
type 2:
- less common
- more severe
- positive LKM1
type 3:
- also less common
- positive anti-soluble liver antigen
management
steroid - prednisolone
maintanence therapy - azathioprine
second line - immunosuppressants
liver transplant - chronic decompensated cirrhosis + failed to respond to immunosuppression
age of onset type 1 and 2
1 - bimodal 10-25 + 45-70
2 - <15yrs
gold standard
liver biopsy
monitoring
- surveillance for those with cirrhosis
- risk of developing HCC is 10-20% over 20 years
if case presents with no differentiating factors, which factor in blood is most common?
anti-smooth muscle (70% of those with AH)
catagorises diagnosis of AH
It is characterised by raised IgG, ALT, and positive anti-smooth muscle antibodies
presence of antinuclear antibodies
only in AH
