Autoimmune Hepatitis

Autoimmune Hepatitis

At this time of writing this article, there is no known cause of autoimmune hepatitis.

Autoimmune hepatitis is hepatocellular inflammation and the organ liver destruction (necrosis) that results in cirrhosis.

Common signs of Autoimmune Hepatitis:

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Usually chronic hepatitis or cirrhosis is established before autoimmune hepatitis is clinically diagnosed.

However, a third of patients with autoimmune hepatitis in the acute phase shows signs of yellowing of eyes and skin, fever and tenderness in the hepatic region.

Others shows marked signs of chronic liver disease, with symptoms of liver failure, coagulopathy and jaundice (yellowing of eyes & skin).

Upon physical examination, extrahepatic diseases associated with autoimmune hepatitis.

Common symptoms of Autoimmune Hepatitis:

  • amenorrhea
  • chest pain from pleuritis
  • myalgia
  • upper abdominal discomfort
  • chest pain from pleuritis
  • weight loss
  • loss of appetite
  • skin rashes
  • acne
  • anorexia
  • fatigue
  • mild pruritus
  • edema
  • athralgias

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Common findings on physical examination:

  • encephalopathy 14%
  • ascites 20%
  • spider angiomata 58%
  • splenomegaly 32%
  • jaundice 69%
  • hepatomegaly 83%

Children/Pediatric Patients Autoimmune Hepatitis findings:

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  • pallor 26%
  • abdominal pain 38%
  • anorexia 47%
  • nonspecific weakness 57%
  • jaundice 58%

Laboratory findings in autoimmune hepatitis include the following:

  • Elevated serum aminotransferase levels (1.5-50 times reference values)
  • Elevated serum immunoglobulin levels, primarily immunoglobulin G (IgG)
  • Mild to moderately elevated serum bilirubin and alkaline phosphatase – In 80-90% of patients; a sharp increase in the alkaline phosphatase values during the course of autoimmune disease may reflect the development of primary sclerosing cholangitis (PSC) or the onset of hepatocellular carcinoma as a complication of cirrhosis
  • Seropositive results for antinuclear antibodies (ANAs), smooth-muscle antibodies (SMAs), or liver-kidney microsomal type 1 (LKM-1) or anti–liver cytosol 1 (anti-LC1) antibodies
  • Hypoalbuminemia and prolongation of prothrombin time – Markers of severe hepatic synthetic dysfunction, which may be observed in active disease or decompensated cirrhosis

Hematologic abnormalities:

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  • mild leukopenia
  • normochromic anemia
  • Coombs-positive hemolytic anemia
  • thrombocytopenia
  • elevated erythrocyte sedimentation rate
  • eosinophillia – not common

Biopsy:

Can clarify the suspicion of autoimmune hepatitis.

Management:

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Corticosteroid prednisone with azathioprine has been used for 30 years to treat autoimmune hepatitis by both American and British healthcare professionals.

Relapse:

The occurence of relapse in autoimmune hepatitis is almost 50% within only six months of stopping treatment.

Eighty percent of patients after 3 years of treatment.

Usually reinstitution of the original treatment induces another remission. The problem is relapse recurs after stopping the treatment a second time.

If the patient relapses twice they require indefinite therapy with prednisone and azathioprine.

Transplant of the Liver:

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Liver transplant can be used for those with decompensated cirrhosis caused by autoimmune hepatitis. Also for those with fluminant hepatic failure secondary to autoimmune hepatitis.

Read about hepatitis C here.