Autoimmune Hepatitis

Question 1

Define Autoimmune hepatitis

Answer 1

AIH is a Inflammatory, autoimmune disease of unknown aetiology
Characterised by high serum auto-AB vs liver enzymes

2 types depending on AB
type 1-ANA, smooth muscle AB, anti-soluble liver Ag
Type 2- anti liver kidney mircosomial 1

Question 2

Aetiology and risk factors of Autoimmune hepatitis

Answer 2

Believed to be the typical genetically predisposed person (type 1 and 2 have different HLA)
then environment trigger (virus, drugs, herbs)
with auto antigens and dysregulation
Seems mainly T cell regulated but has B cell involvement

Risk factors;
Woman 3x
Other AI disease
HLA DR3/4
type 1 -20's and 50's
Type 2 -kids
Virus (Hep, EBV, measles)

Question 3

Epidiemology of Autoimmune hepatitis

Answer 3

Greatest among North European
prevalence -16in 100000 -2.6% of transplant in EU and 5% in US
women 3x > men

type 1-bimodal-20’s then 50’s
type 2-kids

Question 4

Signs and Sx of Autoimmune hepatitis

Answer 4

Non specific-malaise, fatigue, anorexia/weight loss, abdominal discomfort
80%-hepatomegaly
70%-jaundice
60% spider angiomata

Mild pruritus
ARTHRALGIA-signs of AIH

encelopathy-as portal HTN develops
as liver failure/cirrhosis develops-ascites, splenomegaly, GI bleeds (esp massive heamatemasis with portal HTN)
\
very non specific so worth testing if ANY DOUBT

Question 5

Investigations of Autoimmune hepatitis

Answer 5

Aspartate transaminase- sign inflam of liver-HIGH
ALT-High
Bilirubin-elevated
GGT-midly raised
ALP-mild
albumin down, APTT/PT-down
CRP/ESR high

Type 1 -ANA Abs-high, Smooth muscle AB-hgih
anti ds dna-present

Type 2- anti liver kidney mircosomial 1

viral dna usually presents

liver biopsies