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Hepatitis, Autoimmune

Madhavi Singh, MD and Karthika Arulsothynathan, MD Reviewed 06/2021
 


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 × UL...

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
Tunio NA, Mansoor E, Sheriff MZ, et al. Epidemiology of autoimmune hepatitis (AIH) in the United States between 2014 and 2019: a population-based national study. J Clin Gastroenterol. 2020...

ADDITIONAL READING

Takahashi A, Abe M, Yasunaka T, et al. Quality of life among patients with autoimmune hepatitis in remission: a comparative study. Medicine (Baltimore). 2020Oct...

SEE ALSO

Algorithms: Cirrhosis; Hyperbilirubinemia and Jaundice 

CODES

ICD10

K75.4 Autoimmune hepatitis 

SNOMED

408335007 Autoimmune hepatitis (disorder) 

CLINICAL PEARLS

  • AIH is a t-cell mediated autoimmune response in genetically predisposed individuals. AIH disproportionately affects women.

  • Presentation of AIH ranges broadly from asymptomatic elevation...

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