Last reviewed: December 2018
Last updated: March  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • fatigue/malaise
  • anorexia
  • abdominal discomfort
  • hepatomegaly
  • jaundice
  • encephalopathy

Other diagnostic factors

  • pruritus
  • arthralgia
  • nausea
  • fever
  • spider angiomata
  • GI bleeding
  • splenomegaly
  • ascites

Risk factors

  • female gender
  • genetic pre-disposition
  • immune dysregulation
  • measles virus
  • CMV
  • EBV
  • hepatitis viruses A, C, and D
  • certain drugs

Diagnostic investigations

1st investigations to order

  • AST
  • ALT
  • bilirubin
  • gamma-GT
  • alkaline phosphatase
  • serum globulin
  • serum albumin
  • prothrombin time
Full details

Investigations to consider

  • ANA (anti-nuclear antibodies)
  • SMA (smooth muscle antibodies)
  • anti-SLA/LP (anti-soluble liver antigens or liver/pancreas)
  • p-ANCA (perinuclear anti-neutrophil cytoplasmic antibodies)
  • anti-ssDNA (antibodies against single-stranded DNA)
  • anti-dsDNA (antibodies against double-stranded DNA)
  • anti-LKM-1 (antibodies to liver/kidney microsome type 1 antigen)
  • anti-LKM-3 (antibodies to liver/kidney microsome type 3 antigen)
  • anti-LC1 (antibodies to liver cytosol 1 antigen)
  • AMA (anti-mitochondrial antibodies)
  • IgM anti-HAV
  • anti-HBc
  • hepatitis C antibodies and viral RNA
  • ceruloplasmin
  • alpha-1 antitrypsin
  • serum iron and TIBC
  • thiopurine methyltransferase (TPMT) activity
  • abdominal ultrasound
  • liver biopsy
Full details

Emerging tests

  • AAA (anti-actin antibodies)
  • anti-ASGP-R (antibodies against asialoglycoprotein receptor)
Full details

Treatment algorithm


Authors VIEW ALL

George Y. Wu

Professor of Medicine

University of Connecticut School of Medicine




GYW presents lectures on autoimmune hepatitis and is a member of the medical advisory boards for Gilead Sciences, Intercept Pharmaceuticals, and Bristol-Myers Squibb.

Roopjeet K. Bath

Gastroenterology/Hepatology Fellow

University of Connecticut School of Medicine




RKB declares that she has no competing interests.

Dr George Y. Wu and Dr Roopjeet K. Bath would like to gratefully acknowledge Dr Micheal Tadros, Dr Lucija Virovic Jukic, Dr Marcy L. Coash, and Dr Deepika Devuni, previous contributors to this monograph. Dr Wu would also like to acknowledge the assistance of Dr Nathan Selky in the 2011 update. MT, LVJ, MLC, and DD declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Division of Gastroenterology

Department of Medicine

Brown University



KP declares that he has no competing interests.

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