Lecture 29 - Medical Mgmt of Non-viral Hepatitis

Question 1

There are two types of Autoimmune Hepatits:

1. Type 1 is characterized by the following autoAbs: ___, ____, and Anti-____. Which of these has the worst prognosis?
2. Type 2 characterized by the following autoAbs: Anti-___1,3 and Anti-___.

Which type is most common in the US?

Which type is rare in Adults?

Which type usually accompanies extra-hepatic diseases?

Which type is associated with lower levels of IgG?

Answer 1

ANA, ASMA, Anti-SLA

Anti-SLA has worst prognosis.

Anti-LKM1,3

Anti-LC1

Type 1

Type 2

Type 2

Type 2 (also more likely to progress to cirrhosis)

Question 2

According to the Simplified Diagnosstic Criteria for AIH, Definite AIH is defined as a score greater than or equal to ____. Probably AIH is a score greater than or equal to ___, WITHOUT positive liver _______.

ANA or SMA value greater than or equal to ___:___ scores 1 point.

ANA or SMA value greater than or eqaul to ___:___ scores 2 points.

LKM value greater than or equal to ___:___ scores 2 points.

SLA/LP –> any titer at all scores _____ points.

Keep in mind the patient can only gain a max of 2 points from all of the above categories combined. So next, look to ______ –> if it is above normal but below 1.1x the upper limit, score 1 point. If it’s greater than 1.1x upper limit, score 2 points.

Absence of viral hep scores ____ points, while presence scores ____ points.

Note: Liver histology MUST be positive for definitive diagnosis –> if it’s negative, you can only get as high as Probable AIH.

Answer 2

Definite –> greater than or equal to 7

Probable –> Greater than or equal to 6 WITHOUT positive Liver Histology.

1: 40 –> 1 point
1: 80 –> 2 points

LKM 1:40 –> 2 points

SLA/LP –> any titer scores 2 points

IgG

2 points

0 points

Question 3

AIH histology will typically present with ______ hepatitis –> immune cells that pass the Limiting Pate.

It can also present with _____ cell infiltrate and ______ formation (hepatocytes in circular pattern).

Answer 3

Interface hepatitis

Plasma cell infiltrate

Rosette

Question 4

First line treatment for AIH includes _______ +/- Immunosuppression (i.e. Azothioprine).

Second line options include ________ Mofetil, Cyclosporine, or Tacrolimus.

Answer 4

Corticosteroids

Mycophenolate Mofetil