3.12. Liver + Biliary Tree Disease - Autoimmune Hepatitis

Question 1

What is the Aetiology of Autoimmune Hepatitis?

Answer 1

It is unknown

Question 2

Is Autoimmune Hepatitis more common in Males or Females?

Answer 2

Females

Question 3

What can Autoimmune Hepatitis be related to?

Answer 3

Other autoimmune conditions

Question 4

What is required for Autoimmune Hepatitis to occur?

Answer 4

1. A Genetically Predisposed Host

2. An External Environmental Factor

Question 5

What is the Pathology of Autoimmune Hepatitis?

Answer 5

The Environmental Factor causes a sequence of T-Cell mediated events against Liver Antigens

Question 6

What is an example of what the Environmental Factor could be?

Answer 6

A Virus

Question 7

What do the T-Cell mediated events against the Liver result in?

Answer 7

A Necroinflammatory response

Question 8

When are the 2 peak onsets for women with Autoimmune Hepatitis?

Answer 8

1. Peri-menopausal

2. Post-menopausal

Question 9

What is the Clinical Presentation of Autoimmune Hepatitis?

Answer 9

1. Asymptomatic
2. Fatigue
3. Acute Hepatitis
4. Jaundice
5. High Aminotransferase Levels (AST and ALT)
6. Hepatmegaly
7. Splenomegaly
8. Flu-like Symptoms

Question 10

When can Autoimmune Hepatitis appear Asymptomatic until?

Answer 10

1. The Liver becomes Cirrhotic

2. There is an Abnormality in the Liver Biochemistry

Question 11

When does Acute Hepatitis occur as a result of Autoimmune Hepatitis?

Answer 11

In the Young

Question 12

What type of Jaundice occurs?

Answer 12

Intrahepatic Jaundice

Question 13

Do the High Aminotransferase Levels (AST and ALT) improve over time?

Answer 13

No

Question 14

Why does Hepatomegaly occur?

Answer 14

Due to the Necroinflammatory Response within the Liver

Question 15

Why does Splenomegaly occur?

Answer 15

Due to the Backlog of Blood Pressure (Portal Hypertension) from the Liver

Question 16

What Flu-like Symptoms can a patient present with? And why?

Answer 16

Fever, Malaise, Rigors, Sweating - Due to the internal damage of the Liver

Question 17

What investigations are Required in Autoimmune Hepatitis?

Answer 17

1. Liver Function Test (and Biochemistry)
2. Haematological Investigation
3. Auto-antibody Investigation
4. Biopsy

Question 18

What is Tested in a Liver Function Test (and Biochemistry)?

Answer 18

Liver Function Test:

1. Serum Albumin
2. Prothrombin Time

Liver Biochemistry:

1. Bilirubin
2. Alkaline Phosphatase
3. Gamma-Glutamyl Transpeptidase
4. Aminotransferases:
   a) Aspartate Aminotransferase
   b) Alanine Aminotransferase

Question 19

What would be seen in a Liver Function Test (and Biochemistry) of a patient with Autoimmune Hepatitis?

Answer 19

1. High Serum Aminotransferases
2. Elevations in Serum Bilirubin and Alkaline Phosphatase
3. High Gamma-Glutamyl Transpeptidase
4. High Prothrombin Time

Question 20

What is the Haematological Investigation looking for?

Answer 20

Mild Normochromic, Normocytic Anaemia, with Thrombocytopenia and Leukopenia

Question 21

What are the 2 Types of Auto-antibody which can cause Autoimmune Hepatitis?

Answer 21

1. Type 1

2. Type 2

Question 22

What do Type 1 Auto-antibody’s consist of?

Answer 22

1. Anti-Nuclear Antibodies (ANA)
2. Anti-Smooth Muscle Antibodies (Actin)
3. Anti-Soluble Liver Antigen (Anti-SLA)

Question 23

What do Type 2 Auto-antibody’s consist of?

Answer 23

Anti-Liver/Kidney Microsomal (Anti-LKM-1)

Question 24

What is the purpose of the Biopsy?

Answer 24

To see how far the Changes of Autoimmune Hepatitis have occurred

Question 25

What type of drugs are used to treat Autoimmune Hepatitis?

Answer 25

Steroids (Immunosuppression)

Question 26

Which Drugs are used in the Treatment of Autoimmune Hepatitis?

Answer 26

1. Prednisolone
2. Budesonide
3. Azathioprine

Question 27

What type of Drug is Azathioprin?

Answer 27

A Steroid Sparing Agent

Question 28

When can Cirrhosis occur due to Autoimmune Hepatitis?

Answer 28

At a late stage