Autoimmune Hepatitis Board and Resident Review Points



This is a concise review of Autoimmune Hepatitis (AIH) to help you prepare for your board exam:

Overview

Autoimmune hepatitis is a chronic inflammatory liver disease characterized by:

  • Circulating autoantibodies
  • Elevated serum globulin levels
  • Histological features such as interface hepatitis and periportal necrosis

Epidemiology

  • Predominantly affects women (female to male ratio for type 1 AIH is 4:1; for type 2 AIH, it’s 10:1)
  • Incidence and prevalence vary globally, with higher rates in certain regions

Clinical Presentation

  • Acute hepatitis: Sudden onset with symptoms like jaundice, fatigue, and abdominal pain
  • Chronic hepatitis: Insidious onset with mild symptoms or asymptomatic
  • Fulminant hepatic failure: Rare but severe presentation

Diagnosis

  1. Serological Tests:
    • Autoantibodies: ANA, SMA, LKM-1, p-ANCA and SLA/LP
    • Elevated IgG levels
  2. Liver Biopsy:
    • Interface hepatitis
    • Plasma cell infiltration
    • Hepatocyte rosettes
    • Periportal necrosis
Associated Autoimmune diseases are common and include Sjogren syndrome, ulcerative colitis, diabetes type 1, thyroiditis, and systemic lupus erythematosus (SLE).

Treatment

  • First-line therapy: Corticosteroids (e.g., prednisone) often combined with azathioprine
  • Second-line therapy: For non-responders or those with severe side effects, options include mycophenolate mofetil, tacrolimus, or cyclosporine
  • Liver transplantation: Considered for patients progressing to liver failure


Mnemonic for Diagnosis and Treatment of Autoimmune hepatitis

“AIM for AIH”:

  • Autoantibodies (ANA, p-ANCA, SMA, LKM-1, SLA/LP)
  • IgG elevated
  • Medications (Corticosteroids, Azathioprine, Mycophenolate)


For further reading get the Current book.

        This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services. Please refer to your doctor for medical advice.