Autoimmune Hepatitis

Autoimmune hepatitis, like other autoimmune diseases, is that your immune system cannot recognize your own liver tissue and attacks your own liver cells, which leads to inflammation of the liver. The exact mechanisms are unknown. Autoimmune hepatitis may progress to cirrhosis, develop complications, and may require a liver transplant.

There are two types of autoimmune hepatitis:

  • Type 1 autoimmune hepatitis. This is the most common type. It happens at any age.
  • Type 2 autoimmune hepatitis. This is the less common type. It occurs mostly in young children, especially female children.

Causes and risk factors:

Common risk factors for autoimmune hepatitis are:

  • Female gender
  • Some medications
  • History of bacterial or viral infection
  • Family history of autoimmune hepatitis

Diseases associated with autoimmune hepatitis

  • Common ones are:
  • Inflammatory bowel disease
  • Celiac disease
  • Graves disease
  • Hashimoto's thyroiditis
  • Rheumatoid arthritis
  • Scleroderma
  • Sjogren syndrome
  • Systemic lupus erythematosus
  • Type 1 diabetes
  • Hemolytic anemia
  • Pernicious anemia
  • Thrombocytopenic purpura

Symptoms and Signs

Patient that has autoimmune hepatitis may have no symptoms. The most common symptoms are:

  • Fatigue
  • Jaundice
  • Dark urine
  • Itching
  • Rash
  • Joint pain
  • Nausea
  • Vomiting
  • Diarrhea
  • Decreased appetite
  • Upper abdominal discomfort
  • Abnormal period

Once cirrhosis happens, the patient has tendency to have bleeding, infection, fluid in the belly, swelling in the legs, yellow skin and eyes, confusion and coma, renal failure, difficulty breathing, cancer, etc. Patient with cirrhosis should be evaluated for liver transplant.

Diagnosis and Treatment

Diagnosis is to find specific features for autoimmune hepatitis, rule out other causes, to assess liver damage and effects to other organs. This usually involves one or more of the following tests:

  • Blood works. Especially these markers: AIH-1 - ASMA and ANA, AIH-2 - Anti–LKM-1 antibody, AIH-3 - Antibodies to soluble liver antigen (anti-SLA)
  • Paracentesis
  • Abdominal ultrasound
  • CT scan
  • MRI/MRCP
  • Liver biopsy
  • Endoscopy
  • ERCP
  • EUS

Treatment is to suppress the immune reaction by medications, to minimize side effects, to manage complications, etc.

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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