Autoimmune hepatitis occurs when the body’s own immune system begins to attack the liver and causes inflammation. The cause of autoimmune hepatitis is unknown but prior infections, genetic predisposition, some toxins or drugs, and some diseases may play a role. Autoimmune hepatitis is not contagious and is classified as either type 1 or type 2, with type 1 being the most common in the United States.
Autoimmune hepatitis may lead to scarring of the liver and could progress to liver cirrhosis, which is extensive liver scarring and hardening of the liver.
The cause of autoimmune hepatitis is usually unknown, but some items have been found to correspond with the disease itself.
Immunosuppression: Patients who have immunosuppressive disease processes such as ulcerative colitis, type 1 diabetes, rheumatoid arthritis, Sjogren syndrome, and Grave’s disease may be more susceptible to autoimmune hepatitis.
Genetic predisposition: Most patients with autoimmune hepatitis have a first-degree relative such as parent, sibling, grandparent with the condition. This disease is most prevalent in females.
Environmental factors: Most scientists believe that autoimmune hepatitis is triggered by a combination of environmental triggers and genetic predisposition. Viruses such as hepatitis A, B, or C, Epstein-Barr virus, or cytomegalovirus virus may predispose a patient to autoimmune hepatitis.
Drugs and herbal formulations: Some medications and supplements are thought to play a role in autoimmune hepatitis.
Patients with autoimmune hepatitis may not experience any side effects in the early stages of the disease process. Symptoms may be mild to severe in nature and may develop over time or without warning. • Loss of appetite• Nausea and vomiting • Fatigue• Abdominal discomfort• Joint pain• Itching (pruritus)• Yellowing of the skin and whites of the eyes (jaundice)• An enlarged liver• Abnormal blood vessels on the skin (spider angiomas)• Itching (pruritus)• Rashes• Dark-colored urine• Pale or light-colored stool
Patients should see their doctor as soon as possible for any concerning symptoms, or seek emergent care if symptoms are severe. Primary care physicians may refer patients to a hepatologist for advanced care.
To diagnose autoimmune hepatitis the medical provider or physician will take a thorough history and do a physical assessment. Patients should bring a list of any medications they are taking to their appointment including any over-the-counter drugs, herbal supplements or vitamins. Alternately, patients may bring a list of the medications they are taking including dosage strength and schedule.
During physical examination, the provider will listen to and feel the abdomen to examine the liver, and will review vital signs. Patients may be asked difficult questions regarding sexual history, drug and alcohol use; it is important that these questions are answered truthfully so medical care can be tailored to patient needs. In addition, the following tests may be ordered:
• Blood work• Ultrasound, MRI or CT imaging• Abdominal x-ray• Liver Biopsy
For most people autoimmune hepatitis will be a lifelong condition. With medication management, the majority of patients will respond to treatment, especially those who are diagnosed early in the disease process. The purpose of treatment is to slow an overactive immune system
Several medications may be used to treat autoimmune hepatitis with great success, including steroids such as prednisone or budesonide, as well as immunosuppressive drugs such as Imuran. For those who do not respond to first line medications, additional drugs may be added including other immunosuppressive drugs like methotrexate, mycophenolate, cyclosporine, or tacrolimus.
As not all patients respond to medication and there may be patients who require a liver transplant in order to survive.
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