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Autoimmune Hepatitis

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Autoimmune Hepatitis

  • Epidemiology
  1. Primarily in young women with autoimmune disorders
  2. Prevalence: 11 to 17 in 100,000 persons
  • Associated Conditions
  1. Hypergammaglobulinemia (IgG levels up to 3x normal)
  • Labs
  1. Transaminases Moderately elevated
    1. Alanine Aminotransferase (ALT) 150-1000
    2. Aspartate Aminotransferase (AST) 150-1000
  2. Cholestasis Labs elevated
    1. Gamma glutamyl transferase (GGT) elevated
    2. Alkaline Phosphatase
  3. Liver Function Tests abnormal
    1. Albumin depressed
    2. ProTime prolonged
    3. Bilirubin elevated
  • Diagnosis
  1. Exclude other liver disease
  2. Serum Protein Electrophoresis
    1. IgG levels 1.2 to 3 times normal
    2. High Negative Predictive Value for Autoimmune Hepatitis
  3. Specific Labs (False Negative: 10-20%)
    1. Antinuclear Antibody (ANA)
    2. Smooth Muscle Antibody (SMA)
    3. Anti-LKM Microsome type 1 Antibody
  • Management
  1. See Prevention of Liver Disease Progression
  2. Corticosteroids
    1. Significantly improve survival
  • Course
  1. Severe progressive liver disease is more typical
  • References
  1. Manns (2010) Hepatology 51(6):2193-13 [PubMed]