Gatro: Hepatitis

Question 1

Antibodies associated with autoimmune hepatitis

Answer 1

ANA and anti-SMA

Question 2

Who does autoimmune hepatitis usually affect?

Answer 2

Women typically between 20-40 years old

Question 3

Presentation of autoimmune hepatitis?

Answer 3

At presentation:
25% asymptomatic
50% clinically jaundiced
30% cirrhosis

Non-specific symptoms: fatigue, anorexia, weight loss, fever, abdominal pain amenorrhoea

Question 4

Conditions closely associated with autoimmune hepatitis

Answer 4

autoimmune thyroid disease
T1DM
Coeliac - important as lack of absorption affects treatment of AIH

Question 5

Bloods raised in autoimmune hepatitis

Answer 5

ALT + AST
IgG
ANA
AntiSMA

Question 6

How to definitively diagnose autoimmune hepatitis

Answer 6

Liver biopsy

Question 7

Management of autoimmune hepatitis

Answer 7

immunosuppressive therapy: prednisolone or azathioprine often used
Liver transplant if cirrhosis and liver failure

Question 8

What suggests moderate to severe autoimmune heptitis?

Answer 8

AST >5 times the normal serum level
Immunoglobulins >2 times the normal serum level
Liver biopsy showing necrosis

Question 9

Adjunct treatment for autoimmune hepatitis?

Answer 9

Vaccination against hep A and B
Calcium + Vit D supplements

Question 10

How is Hep A spread

Answer 10

Faecal oral route

Question 11

Four stages of infection hep A?

Answer 11

Incubation phase
- approx 28 days

Prodromal phase
- early symptoms
- 3-10days
- flu-like illness, GI upset (appetite loss, RUQ pain, D&V) and low-grade temperatures

Icteric Phase
- established infection
- 1 to 3 weeks, can last up to 12 weeks
- jaundice, pale stools and dark urine, pruritis , hepatomegaly, splenomegaly

Convalescent phase
- recovery after acute illness
- May last up to 6 months
- muscle weakness, malaise, anorexia and hepatic tenderness

Question 12

How to investigate for Hep A?

Answer 12

PCR test for hepatitis A RNA.
If this is not available
- hepatitis A igM
- hepatitis A igG

Question 13

Positive hep A IgM and positive hep A IgG
Negative hep A IgM and positive hep A IgG
High IgG reactivity and a moderate level of IgM

Answer 13

Acute hepatitis A infection
Hepatitis A infection or immunity
Recent infection rather than acute infection

Question 14

Management hep A

Answer 14

Supportive
Notifiable disease
FU LFTs every 2 weeks until resolved