I must tell you that this is a very important topic in MRCP gastroenterology. Besides that, it is rather common in your dily practice if you are attached to the gastroenterology unit. It is an autoimmunedisease with unknown aetiology. Usually questiosn about autoimmune hepatitis would be asked in Part 2and you are expected to know how to interpret liver function test and autoantibody profiles.Patients are usually young ladies.
Clinical Presentations
Patients usually come to you with jaundice and right hypochondrium pain. One important pointto remember about autoimmune hepatitis is that it is commonly associated with other immune diseasesuch as Sjoren's syndrome, Renal Tubular acidosis etc...
Clinical Signs
Patients may have chronic stigmata of chronic liver disease. You may find hepatosplenomegaly. If patient is on treatment, then you would find signs suggesting Cushing's syndrome. Patient mayend up with liver cirhosis and features of hypersplenism.
Investigations
Liver function test reveals increased bilirubin and ALT levels. Autoantibodies that may be positive include ANA ( up to 79-80%), Anti-smooth muscle antibodies, Anti-LKM-1 antibodies and anti-mitochondrial anti-bodies ( rarer in autoimmune hepatitis, you find this more common in primary biliary cirrhosis). Liver biopsy shows PIECEMEAL NECROSIS ( as above slaid)
Treatment
Steroid and steroid sparing agent such as Azathioprine, LIVER TRANSPLANT
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