autoimmune hepatitis

Question 1

define autoimmune hepaptis?

Answer 1

chronic hepatitis of unknown aetiology, characterised by autoimmune features, hyperglobulinaemia and the presence of circulating autoantibodies

Question 2

what is the aetiology of autoimmune hepatitis?

Answer 2

• In a genetically predisposed individual, and environmental agent may lead to hepatocyte expression of HLA antigens
• these then are attached by autoimmune T cells
• then similar changes occur like in chronic viral hepatitis.
• fibrosis and cirrhosis occurs

Question 3

associations with autoimmune hepatitis?

Answer 3

autoimmune disorders, hypergammaglobulinemia, HLA B8, DR3

Question 4

what are the main types of autoimmune hepatitis?

Answer 4

Type I - ANA or SMA

Type II - LKM1

Type III - soluble liver kidney antigen

Question 5

epidemiology of autoimmune hepatitis?

Answer 5

• Most commonly seen in young females

Question 6

presenting symptoms of autoimmune hepatitis?

Answer 6

•	Insidiously present with: 
o	Amenorrhoea  - common
o	Malaise  
o	Fatigue  
o	Anorexia  
o	Weight loss  
o	Nausea  
o	Jaundice  
o	Epistaxis

Question 7

what is a serious presentation of autoimmune hepatitis?

Answer 7

•25% present with	acute hepatitis 
o	Fever  
o	Anorexia 
o	Jaundice  
o	Nausea/Vomiting/Diarrhoea 
o	RUQ pain

Question 8

signs of autoimmune hepatitis?

Answer 8

• Stigmata of chronic liver disease
• Ascites, oedema and hepatic encephalopathy are late features
• Cushingoid features

Question 9

what might the bloods show?

Answer 9

• Raised ALT/AST (due to liver pathology)
• Slight raise in ALP (this suggests bile problem)
• Low: albumin (in severe disease)
o Clotting:
• High PT
o FBC:
• Low Hb, platelets and WCC

Question 10

which antibodies can be present?

Answer 10

• Presence of ANA, ASMA and Anti-LKM1 antibodies raised IgG levels.

Question 11

what is the definitive diagnosis measure for autoimmune hepatitis?

Answer 11

• Liver Biopsy