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Autoimmune Hepatitis Final
Autoimmune Hepatitis Final
Autoimmune Hepatitis Final
Predisposition to autoimmunity is
inherited
actin components
A 50 kd cytosolic protein(tRNP
complex) is target
Abn Normal
cholangiogram chplangiogram
histologic cholangitis cholangitis cholangitis Interface
al hepatitis
Cholestasis Cholestasis Cholestasis
treatment Prednisolone Prednisolone Prednisolone Conventional
tt for AIH
+/- + +/-
ursodeoxycholi ursodeoxycholic ursodeoxycholic
PBC =cprimary
acid acid
biliary cirrhosis acid= primary sclerosing
PSC
cholangitis
CUC = chronic ulcerative colitis AMA= antimitochondrial
CLINICAL FEATURES
Fatigue 85 Hepatomegal 78
y
Jaundice 77 Splenomegal 32
y
Abd 48 Spider 58
discomfort angioma
Pruritis 36 Ascites 20
Anorexia 30 Encephalopat 14
hy
Polymyalgia 30 Immune 48
disease
Fever 18
Other immune disease includes
Disease Percentage
Autoimmune 12%
thyroiditis
Graves disease 6%
Chronic ulcerative 6%
colitis
Rheumatoid arthritis <1%
AST>10-fold of normal
AST > 5 fold of normal with
gammaglobulin >2 fold of normal
Bridging necrosis or multilobular
necrosis
Cirrhosis
Failure to treatment response
Diagnostic algorithm for autoimmune hepatitis
Abn AST & GG level
AST: Alkp > 3
AMA,ceruloplasmin normal
Alfa1 anti trypsin phenotype normal
Normal/non specific Fe level
HBsAg,AntiHCV,IgM antiHAV -ve
type1 type2
LKM1
ANA &/or SMA
TREATMENT
15 mg x 2 wk 30 mg x 2 wk
An improvement that is
insufficient to satisfy remission
criteria
Incomplete
remission Treatment failure Drug toxicity
response