B.2 HEPATITA CRONICA AUTOIMUNA

Question 1

Sexu cel mai frecv afectat

Answer 1

• femeia tanara pana in 40 de ani sau uneori chiar si peste;
• prez. Manif sistemice imunologice (tiroidita autoim, Poliartr. Reumat, PT, anem. Hemolitica) + manif de hep cronica (alat asat × 3-50× VN, variab afectate: albumina, IQ) + manif nesp: febra, astenie, artralgii.

Question 2

Care este patogenia in Boala Hepatitica autoimuna?

Answer 2

-se form. Auto atc (selful devine non self sub act unor fact GENETICI sau EXOGENI) impotriva diferselor prot hepatice (prot de sup de ex: LMK-1).

Question 3

Ce tipuri de fact. Sunt implicati in DECLANSAREA HEP AUTOIMUNE?

Answer 3

• fact gen;
• fact exogeni -> frecv. Inf cu VHC;
  - > medicamentosi: ex alfa metil dopa

Question 4

Dpdv. PARACLINIC, IN tb. BIOLOGIC decelam:

Answer 4

• ALAT / ASAT cresc de 3-50×VN;
• variabilitate: IQ, albumina, bilirubina;
• HIPERGAMAGLOBULINEMIE;
• AUTOATC: ANTI LMK1, ANA, ANTI SM, ANTI LSP.

Question 5

Care sunt MANIF IMUNE CE SURVIN intr-o hepat. cronica AUTOIM?

Answer 5

• tiroidita autoimuna
• amenoree
• anemie hemolitica autoimuna
• purpura trombocitara
• gn. Cronica
• poriartrita reumatoida

Question 6

Care virus hepatitic este DECLANSATOR DE HEPATITA AUTOIMUNA?

Answer 6

-inf. Cu VHC

Question 7

Autoanticorpii SPECIFICI hep. Cron. Autoimune:

Answer 7

Anti SM, ANTI LMK1, ANTI LSP

Question 8

Autoanticorpii din TIPUL 1 DE HEP. AUTOIMUNA:

Answer 8

-anti SM si ANA

Question 9

Care tip de HEPATITA AUTOIMUNA este cel mai frecv intalnit?

Answer 9

Tipul 1.

Question 10

Tipul 2 de HEPATITA AUTOIM prez. Atc de tipul :

Answer 10

-anti LMK 1

Question 10

Tipul 2 de HEPATITA AUTOIM prez. Atc de tipul :

Answer 10

-anti LMK 1

Question 11

Tipul 3 de HEPATITA AUTOIMUNA prez. Atc de tipul:

Answer 11

-anti LSP (LIVER SPECIFIC PROTEIN)

Question 12

Ex. HISTOLOGIC TIPIC RELEVA

Answer 12

-hepatita de INTERFATA ( INFILTRAT INFLA. INTRALOBULAR)

Question 13

Caracteristici tipul 1 de HA:

Answer 13

• anti sm si ana;
• Cea mai frecv (70%)
• preponderent la FEMEI;
• ciroza (50%);
• asociata cu boli autoimune.

Question 14

Caracteristici tipu 2 de HA:

Answer 14

• atc anti LMK 1;
• ambele sexe;
• hipergama glob SEVER CRESCUTA;
• declansata de inf cu VHC;
• CIROZA 80%.

Question 15

Caract. Tipul 3 de HA:

Answer 15

• atc anti LSP;

- cea mai rara.

Question 16

DG. DIFERENTIAL AL HA:

Answer 16

• hepatita acuta ( atc igM anti vhA, vhE);
• hepatita cronica ( mk virali +, mk de autoatc negativi !!! Inf vhc si autoac +!!!);
• deficit de alfa 1 anti trips;
• hepatite cronice medicamentoase -izoniazida (in tbc), alfa metil dopa.
• deficit de ceruloplasmina (B wilson) - tlb neirologice, inelul Kaiser Fleischer, dozare ceruloplasm, cuprinemie si curpinurie;
• hepatita cronica alcoolica : gama glutam transpeptidaza crescute, de ritis > 2; ecografic : hepatita alcoolica->stetatoza->steato fibroza-> ciroza hepatica. Anamnestic cons alcool.
• CBP -PRURIT, BIRILUB, FAL. CRESC, AMA+;
• COLANGITA SCLEROZANTA -FEBRA, AMA-, PRURIT, FAL CRESC, BILIRUB CRESC.

Question 17

Tabloul clinic din CBP:

Answer 17

-prurit intens, BILIRUB, fosfat alc gama gt crescute, -AMA (ATC ANTI MITOCONDRIALI) +.

Question 18

Colangita sclerozanta se caract prin:

Answer 18

• FEBRA, PRURIT CRONIC, INTENS;
• BILIRUB, GAMAGT , FAL CRESCUTE;
• absenta AMA!!!

Question 19

Cum se pine Dg de CBP sau de colangiita sclerozanta?

Answer 19

• ERCP;

- COLANGIO RMN.

Question 20

Tratamentul HAutoimune:

Answer 20

• CTCTP (40-60 mg/ZI);

- AZATHIOPRINA (IMURAN) (2-3 mg/kgc);

Question 21

Alternativa CTCP :

Answer 21

-BUDESONID (CTCTP)

Question 22

Alternativa la AZATHIOPRINA:

Answer 22

• 6-MERCAPTOPURINA;
• MMF;
• CICLOSPORINA;
• METHOTREXAT.

Question 23

Efectele adv ale CTCP:

Answer 23

• acnee
• DZ TIP 2
• necroza asept de cap femural
• psihoza
• osteoporoza
• cataracta
• retentie hidrosalina (HTA)
• infectii
• obezitate

Question 24

Efectele adv ale AZATHIOPRINEI:

Answer 24

• pancr. Acuta
• hepatita colestatica
• boala VENO-OCLUZIVA
• rash
• sdr. EMETIZANT
• supr. medulara.