How Is Autoimmune Hepatitis Diagnosed
Your healthcare provider will look at your health history and give you a physical exam.
Some lab blood tests used to diagnose autoimmune hepatitis include:
- Liver function tests. These check for inflammation or damage to your liver.
- Complete blood count or CBC. Looks at the number and types of cells in your blood.
- Coagulation panel. This test looks at how well the clotting proteins are working.
- Electrolyte panel. Checks to see if you have an electrolyte imbalance.
- Autoimmune antibodies. These are used to see if you have autoimmune hepatitis or another liver disease with similar symptoms.
- Other liver tests. These are done to check for other possible types of liver disease.
You may also have imaging tests such as:
Incomplete Or Failed Response To Treatment
Some people with autoimmune hepatitis have an incomplete response to treatment, meaning that treatment helps but does not lead to remission. If you have an incomplete response to treatment, you may need to take different medicines to help prevent liver damage.
Some people may fail to respond to treatment, meaning that the inflammation and liver damage of autoimmune hepatitis keep getting worse. Your doctor may recommend additional blood tests and higher doses of medicines. If liver damage leads to complications, you may need treatment for complications.
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How Do Doctors Treat Autoimmune Hepatitis
Doctors treat autoimmune hepatitis with medicines that suppress, or decrease the activity of, your immune system, reducing your immune systems attack on your liver. The medicines doctors most often prescribe are corticosteroidsprednisone or prednisolonewith or without another medicine called azathioprine.
Doctors typically start with a relatively high dose of corticosteroids and then gradually lower the dose. Your doctor will try to find the lowest dose that works for you. Your doctor will use blood tests to find out how you are responding to the treatment. A decrease in levels of the liver enzymes alanine transaminase and aspartate transaminase shows a response to treatment. ALT and AST falling to normal levels shows a full response. In some cases, a doctor may repeat a liver biopsy to confirm the response to treatment and find out whether the damage has resolved.
Treatment can relieve symptoms and prevent or reverse liver damage in many people with autoimmune hepatitis. Early treatment of autoimmune hepatitis can lower the chances of developing cirrhosis and other complications. A minority of people who have no symptoms or only a mild form of the disease may or may not need medicines.
Autoimmune Hepatitis Blood Panel
This test includes 3 tests which can help to determine if a person has Autoimmune Hepatitis. Autoimmune Hepatitis is a disorder in which the body’s own immune system mistakenly targets cells in the liver. There are 2 primary types of Autoimmune Hepatitis. Type 1 is more common and often affects people with other types of autoimmune disorders such as Sjogren’s Syndrome, Type 1 Diabetes, and Ulcerative Colitis. Type 2 is less common but tends to be more severe. Common symptoms include fatigue, abdominal pain, jaundice , skin rash, joint pain, and irregularities in the menstrual cycle. Not all people will experience the same symptoms and some people may not have any symptoms until the disease is in its later stages. If left untreated, autoimmune hepatitis can lead to cirrhosis and liver failure.
This package includes the following tests:
- Antinuclear Antibodies
- Actin Smooth Muscle Antibody
- Liver-Kidney Microsomal Antibody
Turnaround for test results is typically 3-5 business days.
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What Causes Autoimmune Hepatitis
Experts dont know what causes autoimmune hepatitis, but it is more likely to show up in people with other autoimmune conditions, including:
- Fluid buildup in the belly
- Rectal bleeding or vomiting blood
The symptoms of autoimmune hepatitis may look like other health problems. Always see your healthcare provider for a diagnosis.
When To Start Treatment
Treatment should be started in patients with significant disease, characterized by at least one of the following: AST or ALT > 10 times the upper limit of normal AST or ALT > 5 times the upper limit of normal and IgG > 2 times the upper limit of normal bridging necrosis or multiacinar necrosis on histology. Although uncommon, the presence of incapacitating symptoms has also been proposed as an indication of treatment regardless of laboratory values.
In asymptomatic patients with AST, ALT, and gamma globulins/IgG elevations that do not meet the criteria above, the benefit of treatment is less clear. The course of the disease in such patients has not been well established and there is little data to support treatment. Thus in asymptomatic patients with only mild laboratory and histological changes, the decision to start treatment should be individualized and the risks of therapy taken into account. Often treatment in this situation can be postponed and liver tests followed closely. Such patients should always be referred to a hepatologist or gastroenterologist for decision regarding therapy.
Asymptomatic patients with inactive disease on liver biopsy or burned out cirrhosis do not benefit from treatment.
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What Is Autoimmune Hepatitis
The liver is a large organ that sits up under your ribs on the right side of your belly . It helps filter waste from your body, makes bile to help digest food, and stores sugar that your body uses for energy. Autoimmune hepatitis occurs when your bodys infection-fighting system attacks your liver cells. This causes swelling, inflammation and liver damage.
It is a long-term or chronic inflammatory liver disease.
- May occur at any age
- Affects women more than men
- Is often linked to other diseases where the body attacks itself
What Is A Possible Complication Of Autoimmune Hepatitis And Cirrhosis
People with autoimmune hepatitis and cirrhosis are at risk of developing liver cancer. A health care provider will monitor the person with a regular ultrasound examination of the liver. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images anesthesia is not needed. The images can show the liver’s size and the presence of cancerous tumors.
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Diagnosing Autoimmune Hepatitis In Children
The liver is a large organ in the abdomen that performs many important tasks: It removes toxins from the blood, makes substances that aid in digestion and blood clotting, and stores vitamins and minerals needed throughout the body.
Hepatitis refers to any inflammation of the liver. Autoimmune hepatitis occurs when the immune system, which normally protects the body from infection, attacks healthy cells in the liver, causing chronic inflammation. Without treatment, this inflammation can cause scarring in the liver, known as cirrhosis, and ultimately, liver failure.
Doctors at Hassenfeld Childrens Hospital at NYU Langone have extensive experience in diagnosing and treating autoimmune hepatitis in children.
Complete Blood Cell Count And Other Blood Studies
Other hematologic abnormalities may include the following:
Elevated erythrocyte sedimentation rate
Eosinophilia is uncommon, but counts ranging from 9% to 48% are described. Autoimmune hepatitis has even been described as the sole presenting feature of idiopathic hypereosinophilic syndrome .
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Genetics And Predisposing Factors
Autoimmune hepatitis is thought to result from an environmental trigger in a genetically predisposed individual, leading to loss of tolerance of T lymphocytes with subsequent hepatocyte attack.
It is a polygenic disease and does not follow a Mendelian distribution. Therefore there is no need to screen family members of patients with AIH. There is a strong genetic association with the alleles of the major histocompatibility complex class II. The presence of human leukocyte antigen genes HLA DRB1*03 and HLA DRB1*04 predisposes to AIH type 1 and affect the disease course and response to treatment. Individuals who are positive for HLA DRB1*03 are younger, respond less favorably to corticosteroid therapy, and progress more often to liver failure. On the other hand, the presence of HLA DRB1*04 is associated with higher rates of concomitant autoimmune disorders.
Autoimmune hepatitis can also be associated with autoimmune polyendocrinopathy candidiasis ectodermal dystrophy syndrome, an autosomal recessive disease characterized by hypoparathyroidism, adrenal insufficiency, and chronic mucocutaneous candidiasis. Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy is the only AIH-associated disease that follows a Mendelian pattern of inheritance and genetic counseling should be offered for patients and family members.
Table 1: Drugs Associated With Drug-Induced Autoimmune-Like Hepatitis
What Are The Symptoms Of Autoimmune Hepatitis
The most common symptoms of autoimmune hepatitis are
- light-colored stools
- jaundice, or yellowing of the skin and whites of the eyes
Symptoms of autoimmune hepatitis range from mild to severe. Some people may feel as if they have a mild case of the flu. Others may have no symptoms when a health care provider diagnoses the disease however, they can develop symptoms later.
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Who Should Get Tested For Autoimmune Hepatitis
Those who exhibited symptoms of liver problems will most likely have to take the autoimmune hepatitis test, especially if they are at a higher risk for the condition.
These risk factors include genetics which suggests that if the autoimmune disease runs in your family, you will have to go through lab work.
Also, those who already have an autoimmune disease like rheumatoid arthritis and celiac disease could also develop autoimmune hepatitis.
Blood Tests For Autoimmune Diseases
Diagnosing autoimmune diseases can be a lengthy process: It can take more than five years to accurately diagnose an autoimmune disease. There is no one test that can diagnose all 80 types of autoimmune diseases.
However, some blood tests can show whether there is an inflammatory process going on in your body, which is a characteristic of autoimmune diseases, and help point the way to the correct diagnosis. More specialized tests are available to pinpoint the exact disease.
This article discusses the various blood tests that may be ordered to diagnose an autoimmune disease, how they’re interpreted, and what information each can provide.
Verywell / Michela Buttignol
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How To Prepare For Your First Appointment With A Hepatologist
Think through the questions that the doctor may ask you. Schedule some time to sit down and take notes before the appointment. Write down each of your symptoms and how long they have been going on. Think about any family members who have a history of liver disease or autoimmune conditions, and write them down as well. Finally, create a list of all of the medications, vitamins, and supplements you are currently taking.
Summary Table: Most Common Causes Of Viral Hepatitis
|Infected needle or blood, sexual contact||Infected needle or blood, sexual contact|
|Either sudden or slow, unnoticed||Usually slow, unnoticed|
|Usually slow-developing and symptoms not specific or strong|
|Testing to Diagnose Acute Infection||HAV-Ab, IgM||Anti-HCV, HCV RNA|
|Testing to Diagnose Chronic Infection or to Monitor Treatment||N/A||HBsAg, HBV DNA, HBeAg, Anti-HBe||Anti-HCV , HCV RNA or viral load, HCV genotype|
|Tests that Detect Previous Infection||HAV-Ab, IgG|
|Chronic form – Interferon, entecavir, tenofovir, lamivudine, adefovir||Chronic form – Interferon|
PreventionThe incidence of new cases of viral hepatitis has decreased due to use of safe injection and safe sex practices and the availability of vaccines for hepatitis A and hepatitis B . Screening units of blood for hepatitis B and C has virtually eliminated infections through blood transfusions. A systematic programme to screen pregnant mothers for hepatitis B and to vaccinate all newborns with infected mothers has greatly decreased new cases of hepatitis B.
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Do Medicines Used To Treat Autoimmune Hepatitis Have Side Effects
Medicines for autoimmune hepatitis can cause side effects. Your doctor will monitor any side effects and help you manage them while you take these medicines. Your doctor also may adjust the doses or change the medicines you take. You may need to stop taking corticosteroids or azathioprine if you have severe side effects.
Side effects of corticosteroids may include
- changes in how you look, which may include weight gain, a fuller face, acne, or more facial hair
Corticosteroids and azathioprine suppress, or decrease the activity of, your immune system, which increases your risk for infections. These medicines can also increase your risk of developing cancers, especially skin cancers.
Complementary And Alternative Medicines
Many complementary and alternative medicines available suggest they can ease the symptoms of liver disease. As with any other medicine, you should use them with care. Your doctor or a registered dietitian will have full access to your medical history and be able to offer advice on treatments that are specific to you and will not interact with any of your other medications.
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What Abnormal Results Mean
Blood tests for autoimmune diseases are not wholly accurate. They can have false negative results and false positive results .
A weakly positive or low titer positive test for autoimmune disease is often not due to any disease.
A positive test on the panel may be a sign of autoimmune hepatitis or other autoimmune liver disease.
If the test is positive mostly for anti-mitochondrial antibodies, you are likely to have primary biliary cholangitis. If the immune proteins are high and albumin is low, you may have liver cirrhosis or chronic active hepatitis.
Is An Aih Diagnosis Fatal
If left untreated, autoimmune hepatitis could be fatal. Early diagnosis and treatment are essential to achieving a good prognosis.
For individuals who respond positively to treatment, the 10-year survival rate is about 83.8% to 94%. Without any treatment, 40% to 50% of individuals with severe autoimmune hepatitis will die within six months to five years.
National Organization for Rare Disorders. Autoimmune hepatitis.
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What Are Autoimmune Diseases
Autoimmune diseases are disorders in which the body’s immune system attacks the body’s own cells and organs with proteins called autoantibodies this process is called autoimmunity.
Autoimmune Hepatitis is a Chronic Disease of the Liver
The body’s immune system normally makes large numbers of proteins called antibodies to help the body fight off infections. In some cases, however, the body makes autoantibodies. Certain environmental triggers can lead to autoimmunity. Environmental triggers are things originating outside the body, such as bacteria, viruses, toxins, and medications.
Signs & Symptoms Of Autoimmune Hepatitis
Most cases of early autoimmune hepatitis have no symptoms and can only be detected by routine blood tests . The symptoms of autoimmune hepatitis differ depending on its severity and may include:
- Itchy skin, dark urine, pale stools, disorientation, abdominal swelling, and leg swelling if the disease gets worse
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When The Liver Is Under Attack
In people with autoimmune hepatitis, immune cells inappropriately mistake the liver’s normal cells as abnormal and attack them. Over time, this can lead to inflammation, scarring , impaired liver function, and even cirrhosis , which can result in liver failure, and death if not treated. Some people may eventually need a liver transplant. The liver disease specialists at NewYork-Presbyterians Center for Liver Disease and Transplantation are experienced in diagnosing and treating autoimmune hepatitis.
How Is Autoimmune Hepatitis Treated
Treatment works best when autoimmune hepatitis is found early. The goal of treatment is to control the disease and to reduce or get rid of any symptoms .
To do this, medicines are used to help slow down or suppress your overactive immune system. They also stop your body from attacking your liver.
Once you have started treatment, it can take 6 months to a few years for the disease to go into remission. Some people can stop taking medicine, but often the disease comes back. You may need treatment now and then for the rest of your life. Some people need to remain on treatment if they have relapsed many times or if their disease is severe.
In some cases autoimmune hepatitis may go away without taking any medicines. But for most people, autoimmune hepatitis is a chronic disease.
It can lead to scarring of the liver . The liver can become so badly damaged that it no longer works. This is called liver failure.
If you have liver failure, a liver transplant may be needed.
Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.
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Autoimmune Disease Markers Can Bedetrimental To Your Health
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