Hepatitis (GI) Flashcards
What are two types of hepatitis (non-viral)?
- autoimmune hepatitis - these flashcards focus on AIH
- ischaemic hepatitis
Define autoimmune hepatitis.
Chronic inflammatory disease of the liver of unknown aetiology
Who does autoimmune hepatitis tend to affect more?
Young females (4:1)
What are the three types of autoimmune hepatitis?
- type 1 AIH (classic, 80% of cases) - children and adults
- type 2 AIH - children only
- type 3 AIH
What are the most common antibodies present in type 1 autoimmune hepatitis? (2 + 2)
- antinuclear antibodies (ANA)
- anti-smooth muscle antibodies (ASMA)
- (anti-actin antibodies - AAA)
- (anti-soluble liver antigen - anti-SLA)
What antibodies are present in type 2 autoimmune hepatitis? (1 + 1)
- anti-liver kidney microsomal-1 (anti-LKM-1)
- (anti-liver cytosol - ALC-1)
What antigen is targeted in type 3 autoimmune hepatitis?
Anti-soluble liver antigen (anti-SLA)
What is the aetiology of autoimmune hepatitis?
Idiopathic
What are some examples of autoimmune diseases that autoimmune hepatitis is commonly associated with? (4)
- Hashimoto’s thyroiditis
- Graves disease
- ulcerative colitis
- Coeliac disease
What gene plays a role in autoimmune hepatitis?
HLA gene (HLA-DR3/4)
Genetically predisposed individual –> environment e.g. viruses/drugs may lead to hepatocyte expression of HLA-DR3/4 –> T-cell mediated autoimmune attack against hepatocytes
What is autoimmune hepatitis characterised by?
Presence of circulating autoantibodies with a high serum globulin concentration (hyperglobulinaemia), inflammatory changes on liver histology (chronic inflammation) and a favourable response to immunosuppressive treatment
When can ischaemic hepatitis occur?
Following acute hepatic hypoperfusion e.g. after sepsis or cardiac arrest
What is ischaemic hepatitis characterised by? (2)
- marked elevation of AST and ALT 1-3 days after insult
- significant rise in LDH (very sensitive for ischaemic hepatitis)
What are the clinical features of hepatitis? (13)
- fatigue
- malaise
- anorexia
- abdominal discomfort
- hepatomegaly
- splenomegaly
- jaundice
- encephalopathy
- pruritus
- arthralgia
- nausea
- amenorrhoea
- spider naevi
What might you see on examination of hepatitis?
- ascites
- hepatomegaly
- splenomegaly
- jaundice
- spider naevi
- GI bleeding
What are some risk factors for hepatitis? (4)
- female
- genetics
- viral triggers
- drug triggers
What are the first-line investigations in hepatitis? (2)
- LFTs - AST, ALT, BR, GGT
- prothrombin time
What do we see in bloods/LFTs in hepatitis?
- high AST and ALT
- BR, GGT and ALP - mild to moderately increased
- low serum albumin (when synthetic function affected)
- high globulins (hypergammaglobulinaemia)
What do we suspect instead of hepatitis if ALP was raised a lot (rather than mild-moderate)?
Bile duct pathology
What serum autoantibodies can be found in type 1 and type 2 autoimmune hepatitis?
- type 1 AIH: ANA & ASMA
- type 2 AIH: anti-LKM-1
What is characteristic of type 1 autoimmune hepatitis?
Decreased albumin, increased prothrombin time
What is prothrombin time like in hepatitis?
Prolonged PT
What would serum protein electrophoresis show in hepatitis?
Hypergammaglobulinaemia (increased IgG)
Why would a liver biopsy be done in hepatitis and what would it show?
Confirms diagnosis - inflammation and bridging necrosis seen
