Autoimmunity and the liver Flashcards
Who is most likely to be a carrier for Hep B?
Neonates. Immature immune system is less likely to clear the infection.
What HLA types is autoimmune hepatitis associated with?
HLA-DR3 and HLA-DR4
What autoantibodies associated with AIH?
- ANA
- SMA (smooth muscle antibodies)
- Liver-kidney microsomal
What unique labs would you see in AIH?
bilirubin high --Elevated transaminases (500-1000) --HYPER GAMMA globulinemia --positive for autoantibodies HOWEVER, often asymptomatic. Can co-exist with other autoimmune diseases
Presentation of AIH?
Same as general signs of hepatitis
- -Fatigue
- -Dark urine/light stools
- -RUQ discomfort
- -Arthralgia
- -spider nevi
- -Jaundice
- -splenomegaly/hepatomegaly
Unique findings on biopsy of autoimmune hepatitis:
- PLASMA cells
2. Lobular inflammation with rosettes
What could help in your diagnosis of AIH?
Use the scoring system from autoimmune hepatitis group. Definite AIH if you score over 15.
How do you treat autoimmune hepatitis?
Prednisone
-Azathioprine
What’s on your differential with a transaminase level above 1000?
- Acute viral hepatitis
- Autoimmune hepatitis
- Ischemic hepatitis
- Acute drug/toxin injury
What’s on your differential with a transaminase > 10,000
acetaminophen toxicity
ischemic hepatitis
What liver lab finding would make you suspect alcoholic hepatitis?
AST: ALT ratio of 2:1
Typical pt with primary biliary cirrhosis?
Middle aged women
Pathogenesis of primary biliary cirrhosis?
Destruction of interlobular bile ducts (at the microscopic level).
- -Ductopenia
- -Slowly progressive cholestasis
Symptoms of Primary Biliary cirrhosis?
Hyperpigmentation --Pruritis --Xanthomas --Jaundice is a late manifestation Often, normal PE
What lab would you want to order in PBC?
AMA is sensitive and specific for PBC
Histology of PBC
FLORID DUCT LESION is textbook.
–Portal triad with inflammatory cells
How do you treat PBC?
Ursodeoxycholic acid
Typical pt with primary sclerosing cholangitis?
Males much more common
Pathogenesis of primary sclerosing cholangitis
Inflammation, fibrosis, and stricturing of medium nad large bile ducts (as opposed to PBC)
What other disease do you need to watch out for in a pt with primary sclerosing cholangitis?
Ulcerative colitis. If they have UC, then at risk for colon cancer
What are complications of primary sclerosing cholangitis?
- Cholestasis
- Biliary strictures
- Bacterial cholangitis
- Cholangiocarcinoma
Histological findings in primary sclerosing cholangitis?
Onion skinning
How can you tell whether elevated GGT/AP is due to biliary obstruction VERSUS hepatic cholestasis?
Need to image the liver/biliary tree with ultrasound
PSC==Biliary obstruction (larger bile ducts)
PBC:==hepatic cholestasis
