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Hepatitis, Autoimmune

Michelle Martin, PharmD, FCCP, BCPS, BCACP and Jamie L. Berkes, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

A chronic inflammatory disorder of unknown etiology affecting the liver; characterized by periportal necrosis (interface hepatitis or piecemeal necrosis), hypergammaglobulinemia, and...

DIAGNOSIS

HISTORY

  • 40% of cases have abrupt onset. Clinical course often fluctuates.

  • Presentation can range from no symptoms to vague, nonspecific symptoms (right upper quadrant pain, nausea, jaundice, p...

TREATMENT

GENERAL MEASURES

  • Symptomatic therapy (antiemetics)

  • Hepatitis A and B vaccines

MEDICATION

  • Treatment generally indicated if (3)[C]:

    • AST >10 × ULN

    • AST >5 × ULN with serum γ-globulin >2 × U...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Follow AST, ALT, total bilirubin, and IgG every 1 to 3 months during treatment.

  • Treat until levels normalize and liver histology is no longer inflammatory.

Patient Monitoring

REFERENCES

1
van Gerven NM, de Boer YS, Mulder CJ, et al. Auto immune hepatitis. World J Gastroenterol.  2016;22(19):4651–4661. [View Abstract on OvidMedline]
2
Hennes EM, Zeniya M, Czaja AJ, et al;...

ADDITIONAL READING

Koh C, Zhao X, Samala N, et al. AASLD clinical practice guidelines: a critical review of scientific evidence and evolving recommendations. Hepatology.  2013;58(6):2142–2152. [V...

SEE ALSO

Algorithms: Cirrhosis; Hyperbilirubinemia and Jaundice 

CODES

ICD10

K75.4 Autoimmune hepatitis 

ICD9

571.42 Autoimmune hepatitis 

SNOMED

408335007 Autoimmune hepatitis (disorder) 

CLINICAL PEARLS

  • Continue treatment for 3 to 6 months (even if rapid clinical and laboratory improvement) to allow for histologic resolution.

  • ALP: AST (or ALT) ratio of <1.5 suggests AIH.

  • Children wit...

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