Back to Mild to Moderate Aminotransferase Elevation

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.