Autoimmune hepatitis

Background

  • Hepatocellular inflammation caused by autoimmune pathology, ultimately leading to necrosis and cirrhosis
  • Presentation may be acute or chronic, rarely presents as fulminant hepatic failure
  • Usually affects women (~70%[1] between age 15-40 years
  • Often occurs comorbidly with other autoimmune disorders (e.g. type 1 diabetes, thyroid disease, inflammatory bowel disease, Sjorgen's)

Clinical Features

Findings of liver disease and systemic signs/symptoms of autoimmune disorders

Differential Diagnosis

Evaluation

  • LFTs
    • ALT/AST 1.5-50 times normal
    • Mild to moderate elevations in bilirubin and alk phos
  • CBC
  • BMP: evaluate for electrolyte derangements, hypoglycemia, hepatorenal syndrome
  • PT/INR
  • Ammonia if suspect hepatic encephalopathy
  • Paracentesis if suspect SBP
  • Autoantibodies: may have positive ANA, SMA, LKM-1, and/or anti-LC1[2]
  • Evaluate for other causes of liver disease, if not previously diagnosed with autoimmune hepatitis:
  • Consider RUQ ultrasound
  • Definitive diagnosis usually by liver biopsy

Management

Disposition

See Also

External Links

References

Authors:

Claire