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Autoimmune Hepatitis






Introduction

Autoimmune hepatitis is an inflammation of the liver caused by an autoimmune disorder. An autoimmune disorder is one in which a person's immune system attacks his or her own body for unknown reasons.
What is going on in the body?
The exact reason for autoimmune disorders is not known. In autoimmune hepatitis, the immune system attacks the liver and, sometimes, other parts of the body. The degree of liver inflammation can range from mild to deadly.
What are the causes and risks of the condition?
The cause of autoimmune hepatitis is unknown. It may be an isolated condition or may occur as part of another autoimmune disorder, such as systemic lupus erythematosus. Autoimmune hepatitis most often occurs in women between the ages of 15 and 40. While the condition is seen in men, it is eight times more common in women.
New research findings suggest that autoimmune disorders may be triggered by a transfer of cells between the fetus and the mother during pregnancy. The study involved women with scleroderma, an autoimmune disorder involving the skin. These women have more fetal cells in their blood decades after a pregnancy than women who don't have scleroderma. While further research is needed to substantiate these findings, the study does offer an explanation for the much higher incidence of autoimmune disorders in women than in men.  

What are the signs and symptoms of the condition?
Autoimmune hepatitis can cause many symptoms, including:
  • abdominal distress
  • nausea and vomiting
  • jaundice, which is a yellowing of the whites of the eyes and skin
  • dark-colored urine
  • loss of appetite
  • fatigue
  • fever
    • Some individuals with autoimmune hepatitis develop bodywide symptoms such as joint pain, muscle aches, and blood clotting problems.  
    How is the condition diagnosed?
    Hepatitis can be diagnosed with blood tests, such as liver function tests. The provider must then try to figure out the cause of the hepatitis. Conditions such as alcoholism and viral infection of the liver are much more common than autoimmune hepatitis. Further blood tests, including one that measures antibodies to the person's own tissues, often help make the correct diagnosis. Special X-ray tests may be needed as well.
    Sometimes, a liver biopsy may be needed. This procedure involves getting a piece of liver tissue with a special needle inserted through the skin. The piece can then be examined under a microscope in the laboratory.   
    What are the treatments for the condition?
    Autoimmune hepatitis is treated with medications that stop the immune system from attacking the liver. These medications include steroids, such as prednisone, and azathioprine. A liver transplant may be needed if medications don't work or the liver becomes very damaged.
    What are the side effects of the treatments?
    Medications to suppress or stop the immune system can cause allergic reactions, stomach upset, and an increased risk of infection. Liver transplant is major surgery that carries a risk of bleeding, infection, and allergic reaction to the anesthesia.
    What happens after treatment for the condition?
    The outcome for autoimmune hepatitis is often unpredictable. A person may require lifelong therapy or the condition may go away on its own for long stretches of time. A liver transplant generally cures the condition but requires intense treatment and monitoring for years after the transplant.
    How is the condition monitored?
    Regular physical examinations and liver function blood tests are commonly used to monitor autoimmune hepatitis. Any new or worsening symptoms should be reported to the healthcare provider.   


    Reference 
     Harrison's Principles of Internal Medicine, 1998, Fauci et al

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