Summary
Definition
History and exam
Key diagnostic 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 predisposition
- 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
Investigations to consider
- ANA (antinuclear antibodies)
- SMA (smooth muscle antibodies)
- anti-SLA/LP (antisoluble liver antigens or liver/pancreas)
- p-ANCA (perinuclear antineutrophil 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 (antimitochondrial 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
Emerging tests
- AAA (antiactin antibodies)
- anti-ASGP-R (antibodies against asialoglycoprotein receptor)
Treatment algorithm
Contributors
Authors VIEW ALL
Professor of Medicine
University of Connecticut School of Medicine
Farmington
CT
Disclosures
GYW presents lectures on autoimmune hepatitis and is a member of the medical advisory boards for Gilead Sciences, Intercept Pharmaceuticals, and Bristol-Myers Squibb.
Gastroenterology/Hepatology Fellow
University of Connecticut School of Medicine
Farmington
CT
Disclosures
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
RI
Disclosures
KP declares that he has no competing interests.
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