Evaluating Liver Test Abnormalities
Understanding the Pathophysiology of Liver Disease
for Health Care Providers
Autoimmune Hepatitis
Back to Chronic Hepatocellular Injury
Introduction
The pathogenesis of autoimmune hepatitis is not known. It is often associated with other autoimmune diseases such as thyroiditis, lupus, rheumatoid arthritis, type I diabetes, celiac sprue, ulcerative colitis, vitiligo. Although autoimmune hepatitis is generally a chronic condition, it can also present acutely and is a rare cause of acute liver failure.
History
Personal or family history of autoimmune diseases such as thyroiditis, hyper or hypothyroidism, lupus, rheumatoid arthritis, vitiligo, etc
Physical examination
- Hepatomegaly/splenomegaly
- Rash
- Lymphadenopathy
In acute hepatocellular injury, the presence of asterixis (encephalopathy) and coagulopathy defines acute liver failure. Patients should be urgently referred to liver specialists.
Patients with evidence of encephalopathy (confusion/asterixis) should be urgently referred to a liver specialist or a transplant center.
Laboratory investigation
In addition to the relevant investigations based on the clinical presentation, the following liver tests should be ordered:
- Antinuclear antibodies (ANA)
- Anti-smooth muscle antibodies (ASMA)
- Protein electrophoresis (hypergammaglobulinemia)
- Anti-LKM antibodies (if above investigations are negative and autoimmunity is still suspected)
- PT/INR
Patients who develop coagulopathy (prolonged PT/INR) should be urgently referred to a liver specialist or a transplant center.