Autoimmune hepatitis
Updates to Article Attributes
Autoimmune hepatitisis a rare type type of chronic hepatitis, currently classified as "type 1" or "type 2". It may eventually lead to cirrhosis. The role of imaging is primarily to exclude other diagnoses and evaluate for complications.
Epidemiology
It may occur in children or adults, but most patients are affected at 40-60 years old. The incidence in Western Europe is ~0.01-0.02% 2.
There is no predilection for an ethnic group. There is a female predominance: 3.6: 1.
Clinical presentation
It has a variable clinical presentation. Patients may be asymptomatic asymptomatic or present in acute liver failure (rare), or anywhere between. Tends to have a relapsing-remitting course. There is an association with other autoimmune conditions.
Depending on the phase, the patient may present with
- hepatomegaly +/- splenomegaly
- jaundice
- elevated aminotransferases (ALT and AST)
Pathology
Autoimmune hepatitis may encompass multiple different conditions.
Type 1:
- "classic" autoimmune hepatitis
- ANA, IgG4, andanti-smooth muscle antibody may be elevated, with the last (1:320) a relatively more specific finding in type 1
- ANCA is more often found in type 1 than in type 2
Type 2:
- has
antibodiesantibodies to liver/kidneymicrosomesmicrosomes (ALKM-1) ortoto a liver cytosol antigen (ALC-1)
Biopsy and histopathology is less specific for a diagnosis, compared to serum markers.
Radiographic features
The role of imaging in a patient with possible autoimmune hepatitis is threefold:
- to exclude other possibilities of chronic hepatitis
- to look for complications of cirrhosis (such as HCC)
- to look for autoimmune involvement of other organs (such as the pancreas).
CT
Nonspecific, ranging from normal to hepatomegaly and cirrhosis.
MRI
- T2: nonspecific, increased periportal oedema 4
- MRCP: primary sclerosing cholangitis (PSC) should be excluded
Treatment and prognosis
Treatment is similar to other autoimmune conditions, and often uses immunomodulating medications.
Differential diagnosis
- primary biliary cirrhosis (PBC)
- primary sclerosing cholangitis (PSC)
- acute hepatitis from other etiologies
- Wilson disease (mostly paediatric patients)
-<p><strong>Autoimmune hepatitis </strong>is a rare type of chronic hepatitis, currently classified as "type 1" or "type 2". It may eventually lead to <a href="/articles/cirrhosis">cirrhosis</a>. The role of imaging is primarily to exclude other diagnoses and evaluate for complications.</p><h4>Epidemiology</h4><p>It may occur in children or adults, but most patients are affected at 40-60 years old. The incidence in Western Europe is ~0.01-0.02% <sup>2</sup>.</p><p>There is no predilection for an ethnic group. There is a female predominance: 3.6: 1.</p><h4>Clinical presentation</h4><p>It has a variable clinical presentation. Patients may be asymptomatic or present in acute liver failure (rare), or anywhere between. Tends to have a relapsing-remitting course. There is an association with other autoimmune conditions.</p><p>Depending on the phase, the patient may present with</p><ul>- +<p><strong>Autoimmune hepatitis </strong>is a rare type of chronic hepatitis, currently classified as "type 1" or "type 2". It may eventually lead to <a href="/articles/cirrhosis">cirrhosis</a>. The role of imaging is primarily to exclude other diagnoses and evaluate for complications.</p><h4>Epidemiology</h4><p>It may occur in children or adults, but most patients are affected at 40-60 years old. The incidence in Western Europe is ~0.01-0.02% <sup>2</sup>.</p><p>There is no predilection for an ethnic group. There is a female predominance: 3.6: 1.</p><h4>Clinical presentation</h4><p>It has a variable clinical presentation. Patients may be asymptomatic or present in acute liver failure (rare), or anywhere between. Tends to have a relapsing-remitting course. There is an association with other autoimmune conditions.</p><p>Depending on the phase, the patient may present with</p><ul>
-<li>ANA, IgG4, and <a href="/articles/anti-smooth-muscle-antibody">anti-smooth muscle antibody</a> may be elevated, with the last (1:320) a relatively more specific finding in type 1</li>- +<li>ANA, IgG4, and <a href="/articles/anti-smooth-muscle-antibody">anti-smooth muscle antibody</a> may be elevated, with the last (1:320) a relatively more specific finding in type 1</li>
-</ul><p>Type 2:</p><ul><li>has antibodies to liver/kidney microsomes (ALKM-1) or to a liver cytosol antigen (ALC-1)</li></ul><p>Biopsy and histopathology is less specific for a diagnosis, compared to serum markers.</p><h4>Radiographic features</h4><p>The role of imaging in a patient with possible autoimmune hepatitis is threefold:</p><ul>- +</ul><p>Type 2:</p><ul><li>has antibodies to liver/kidney microsomes (ALKM-1) or to a liver cytosol antigen (ALC-1)</li></ul><p>Biopsy and histopathology is less specific for a diagnosis, compared to serum markers.</p><h4>Radiographic features</h4><p>The role of imaging in a patient with possible autoimmune hepatitis is threefold:</p><ul>
-<li><a href="/articles/primary-biliary-cirrhosis">primary biliary cirrhosis (PBC)</a></li>- +<li><a href="/articles/primary-biliary-cholangitis">primary biliary cirrhosis (PBC)</a></li>
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