Hepatitis, Autoimmune

Question 1

what is autoimmune hepatitis

Answer 1

chronic hepatitis characterised by autoimmune features

Question 2

what are the autoimmune characteristics of hepatitis

Answer 2

hyperglobulinaemia and the presence of circulating autoantibodies and favourable response to immunosuppressive treatment. histology will show inflammatory changes to liver tissue

Question 3

aetiology

Answer 3

in a genetically predisposed individual, environmental agents such as viruses or drugs may lead to the hepatocyte expression of HLA antigens which become the focus of a T- cell mediated autoimmune attack

Question 4

pathway of damage

Answer 4

lymphoid infiltration of the portal tracts and hepatocyte necrosis leading to fibrosis

Question 5

difference between Type 1 and Type 2 autoimmune hepatitis

Answer 5

Type 1 is more common and is usually diagnosed in adults. Type 2 is more common in children and often involves a more severe disease process

Question 6

epidemiology

Answer 6

rare condition but affects females 4x more; 4:1 ratio

Type 1; mainly young women but ALL age groups
Type 2; mainly girls and young women

Question 7

how can autoimmune hepatitis be found incidentally

Answer 7

may be asymptomatic and discovered incidentally through LFT’s

Question 8

how can autoimmune hepatitis present

Answer 8

fatigue/ malaise, anorexia, hepatomegaly, abdominal discomfort, jaundice, nausea and fever, pruritus and arthralgia

Question 9

biggest risk factors for developing autoimmune hepatitis

Answer 9

female sex, genetic predisposition and immune dysregulation

Question 10

other causes of hepatitis

Answer 10

viral or alcoholic

Question 11

Investigations for hepatitis

Answer 11

Bloods, liver biopsy, US/CT/MRI of liver and abdomen, ERCP

Question 12

Bloods?

Answer 12

FBC (low Hb, platelets and WCC)
Clotting (high PT in severe cases)
LFT’s (high AST, ALT, GGT, ALP and bilirubin. Low albumin in severe cases)
Hypergammaglobulinaemia (presence of autoantibodies)

Question 13

liver biopsy

Answer 13

to see if this is hepatitis or cirrhosis

Question 14

hepatitis vs cirrhosis?

Answer 14

hepatitis can be reversed in some cases, cirrhosis is permanent scarring and damage of liver tissue.
hepatitis has a more sudden onset whereas cirrhosis develops more gradually

Question 15

why will an ERCP be done

Answer 15

to rule out PSC; primary sclerosing Cholangitis

Question 16

treatment first line

Answer 16

corticosteroids and immunotherapy

preferably liver transplant

Question 17

main immunosuppressive drug used in the treatment of autoimmune hepatitis

Answer 17

azathioprine

Question 18

examples of corticosteroids

Answer 18

prednisolone or prednisone

Question 19

difference between prednisolone and prednisone

Answer 19

The main difference between prednisone and prednisolone is that prednisone must be converted by liver enzymes to prednisolone before it can work. In people with severe liver disease, prednisolone is usually preferred