Diferencia entre revisiones de «Autoimmune hepatitis»
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==Background== | ==Background== <!--T:1--> | ||
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*Hepatocellular inflammation caused by autoimmune pathology, ultimately leading to necrosis and cirrhosis | *Hepatocellular inflammation caused by autoimmune pathology, ultimately leading to necrosis and cirrhosis | ||
*Presentation may be acute or chronic, rarely presents as fulminant [[Special:MyLanguage/hepatic failure|hepatic failure]] | *Presentation may be acute or chronic, rarely presents as fulminant [[Special:MyLanguage/hepatic failure|hepatic failure]] | ||
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==Clinical Features== | ==Clinical Features== <!--T:3--> | ||
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[[File:Jaundice08.jpg|thumb|Jaundice of the skin]] | [[File:Jaundice08.jpg|thumb|Jaundice of the skin]] | ||
[[File:Jaundice.jpg|thumb|Pediatric jaundice with icterus of sclera.]] | [[File:Jaundice.jpg|thumb|Pediatric jaundice with icterus of sclera.]] | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:5--> | ||
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*[[Special:MyLanguage/Viral hepatitis|Viral hepatitis]] | *[[Special:MyLanguage/Viral hepatitis|Viral hepatitis]] | ||
*[[Special:MyLanguage/Acute alcoholic hepatitis|Acute alcoholic hepatitis]], alcoholic liver disease | *[[Special:MyLanguage/Acute alcoholic hepatitis|Acute alcoholic hepatitis]], alcoholic liver disease | ||
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==Evaluation== | ==Evaluation== <!--T:7--> | ||
===Workup=== | ===Workup=== <!--T:8--> | ||
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*[[Special:MyLanguage/LFTs|LFTs]] | *[[Special:MyLanguage/LFTs|LFTs]] | ||
**ALT/AST 1.5-50 times normal | **ALT/AST 1.5-50 times normal | ||
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===Diagnosis=== | ===Diagnosis=== <!--T:10--> | ||
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*Evaluate for other causes of liver disease, if not previously diagnosed with autoimmune hepatitis: | *Evaluate for other causes of liver disease, if not previously diagnosed with autoimmune hepatitis: | ||
**[[Special:MyLanguage/Viral hepatitis|Viral hepatitis]] serologies | **[[Special:MyLanguage/Viral hepatitis|Viral hepatitis]] serologies | ||
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==Management== | ==Management== <!--T:12--> | ||
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*[[Special:MyLanguage/Corticosteroids|Corticosteroids]] +/- [[Special:MyLanguage/Azathioprine|Azathioprine]] | *[[Special:MyLanguage/Corticosteroids|Corticosteroids]] +/- [[Special:MyLanguage/Azathioprine|Azathioprine]] | ||
*Manage complications, see: | *Manage complications, see: | ||
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==Disposition== | ==Disposition== <!--T:14--> | ||
==See Also== | ==See Also== <!--T:15--> | ||
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*[[Special:MyLanguage/Acute hepatitis|Acute hepatitis]] | *[[Special:MyLanguage/Acute hepatitis|Acute hepatitis]] | ||
*[[Special:MyLanguage/Cirrhosis|Cirrhosis]] | *[[Special:MyLanguage/Cirrhosis|Cirrhosis]] | ||
==External Links== | ==External Links== <!--T:17--> | ||
==References== | ==References== <!--T:18--> | ||
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<references/> | <references/> | ||
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[[Category:GI]] | [[Category:GI]] | ||
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Revisión actual - 21:18 6 ene 2026
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, Sjögren's)
- 3 subtypes of autoimmune hepatitis: types 1-3, with type 1 being the most common
Clinical Features
Findings of liver disease and systemic signs/symptoms of autoimmune disorders
- Nausea/vomiting, diarrhea
- Epigastric pain, RUQ pain
- Anorexia
- Jaundice
- Ascites, SBP, edema
- Pruritus
- Fatigue, malaise, weakness
- Arthralgia, myalgia
- Spider angiomata, hirsutism, amenorrhea
- Chest pain due to pleuritis
- Weight loss
- Hepatosplenomegaly
- Hepatic encephalopathy
- Coagulopathy
- GI bleed
Differential Diagnosis
- Viral hepatitis
- Acute alcoholic hepatitis, alcoholic liver disease
- Acetaminophen toxicity and other drug-induced hepatotoxicity (
- Mushroom toxicity
- Ischemic hepatitis
- Non-alcoholic steatohepatitis
- Cardiac cirrhosis
- Primary biliary cirrhosis
- primary sclerosing cholangitis
- Budd-Chiari
- Alpha1 anti-trypsin Deficiency
- Cystic Fibrosis
- Wilson's disease
- Sarcoidosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[2])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Hepatic Dysfunction
Infectious
- Hepatitis
- Malaria
- HIV (present in 50% of AIDS patients)[3]
- EBV
- Babesiosis, leptospirosis
- Typhoid
- Hepatic abscess, amebiasis
Neoplastic
Metabolic
Biliary
- Biliary cirrhosis
Drugs
- Alcoholic cirrhosis
- Alcoholic hepatitis
- Hepatotoxic drugs
Miscellaneous
- Other causes of cirrhosis
- Autoimmune hepatitis
- Veno-occlusive disease
- CHF (right heart failure)
Evaluation
Workup
- LFTs
- ALT/AST 1.5-50 times normal
- Mild to moderate elevations in bilirubin and alk phos
- CBC
- +/- mild leukopenia,
- +/- normocytic or hemolytic anemia
- +/- thrombocytopenia
- BMP: evaluate for electrolyte derangements, hypoglycemia, hepatorenal syndrome
- PT/INR
- Ammonia if suspect hepatic encephalopathy
- Paracentesis if suspect SBP
- Consider RUQ ultrasound and/or MRCP
Diagnosis
- Evaluate for other causes of liver disease, if not previously diagnosed with autoimmune hepatitis:
- Viral hepatitis serologies
- Acetaminophen level
- Autoantibodies: may have positive ANA, SMA, LKM-1, and/or anti-LC1[4] ; ANA & SMA usually positive in type 1 autoimmune hepatitis, LJM-1 and atypical p-ANCA positive in type 2 and liver soluble antigen usually in type 3
- Definitive diagnosis usually by liver biopsy
Management
- Corticosteroids +/- Azathioprine
- Manage complications, see:
- Ultimately, may require transplant
- Hepatology/Gastroenterology consult should be made
Disposition
See Also
External Links
References
- ↑ http://www.liverfoundation.org/abouttheliver/info/aihep/
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
- ↑ Tintanelli's
- ↑ http://emedicine.medscape.com/article/172356-overview