Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- fadiga/mal-estar
- anorexia
- desconforto abdominal
- hepatomegalia
- icterícia
- encefalopatia
Outros fatores diagnósticos
- prurido
- artralgia
- náuseas
- amenorreia
- aranhas vasculares
- febre
- erupção cutânea maculopapular
- hemorragia digestiva
- esplenomegalia
- ascite
Fatores de risco
- sexo feminino
- predisposição genética
- desregulação imune
- vírus do sarampo
- citomegalovírus
- Vírus Epstein-Barr
- vírus das hepatites A, C e D
- certos medicamentos
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- aspartato transaminase
- alanina aminotransferase
- bilirrubina
- gama-glutamiltransferase (gama-GT)
- fosfatase alcalina
- globulina sérica
- albumina sérica
- tempo de protrombina
Investigações a serem consideradas
- fator antinuclear (FAN)
- anticorpos de músculo liso (AMLs)
- antiantígenos solúveis hepáticos ou fígado/pâncreas (anti-SLA/LP)
- anticorpo anticitoplasma de neutrófilo com padrão perinuclear (p-ANCA)
- anticorpos contra ácido desoxirribonucleico de fita simples (anti-ssDNA)
- anticorpos contra DNA de fita dupla (anticorpos anti-dsDNA)
- anticorpos para antígeno microssomal fígado/rim tipo 1 (anticorpos anti-LKM-1)
- anticorpos para antígeno microssomal fígado/rim tipo 3 (anti-LKM-3)
- anticorpos para antígeno citosol hepático tipo 1 (anti-LC1)
- anticorpos antimitocondriais (AAMs)
- anticorpos contra receptor de asialoglicoproteína (anti-ASGP-R)
- anticorpos imunoglobulina M (IgM) contra vírus da hepatite A (IgM anti-HAV)
- teste para o antígeno de superfície da hepatite B (HBsAg)
- anticorpos contra antígeno do núcleo da hepatite B (anti-HBc)
- anticorpos para hepatite C e ácido ribonucleico (RNA) viral
- ceruloplasmina
- alfa 1-antitripsina
- ferro sérico e capacidade total de ligação do ferro
- atividade da tiopurina metiltransferase (TPMT)
- ultrassonografia abdominal
- biópsia hepática
Novos exames
- Elastografia transitória (ET)
Algoritmo de tratamento
doença aguda grave
doença ativa
doença inativa ou doença minimamente ativa com comorbidades
Síndrome de sobreposição de cirrose biliar primária por hepatite autoimune
resposta inadequada à terapia inicial ou recidiva única: sem descompensação hepática
múltiplas recidivas prévias: sem descompensação hepática
doença hepática descompensada
Colaboradores
Autores
George Y. Wu, MD, PhD
Professor Emeritus
Division of Gastroenterology - Hepatology
University of Connecticut School of Medicine
Farmington
CT
Declarações
GYW presents lectures on autoimmune hepatitis nationally and internationally. He has acted as an expert witness for legal firms, is comprehensive editor in chief of the Journal of Clinical and Translational Hepatology, associate editor in chief of Medjaden, associate editor at the Journal of Digestive Diseases, and a book series editor for Springer-Nature, and a consultant in mitochondrial diseases at Mitrix Bio, Inc.
Roopjeet K. Bath, MBBS
Assistant Professor of Medicine
University of Connecticut School of Medicine
Farmington
CT
Disclosures
RKB declares that she has no competing interests.
Acknowledgements
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 topic. Dr Wu would also like to acknowledge the assistance of Dr Nathan Selky in the 2011 update.
Disclosures
MT, LVJ, MLC, and DD declare that they have no competing interests.
Peer reviewers
Kittichai Promrat, MD
Assistant Professor
Division of Gastroenterology
Department of Medicine
Brown University
RI
Disclosures
KP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020 Aug;72(2):671-722.Full text Abstract
European Association for the Study of the Liver. EASL clinical practice guidelines: autoimmune hepatitis. J Hepatol. 2015 Oct;63(4):971-1004. Abstract
Gleeson D, Heneghan MA; British Society of Gastroenterology. British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis. Gut. 2011 Dec;60(12):1611-29.Full text Abstract
Strassburg CP, Manns MP. Treatment of autoimmune hepatitis. Semin Liver Dis. 2009 Aug;29(3):273-85. Abstract
Selvarajah V, Montano-Loza AJ, Czaja AJ. Systematic review: managing suboptimal treatment responses in autoimmune hepatitis with conventional and nonstandard drugs. Aliment Pharmacol Ther. 2012 Oct;36(8):691-707.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Cirrose biliar primária
- Colangite esclerosante primária
- Hepatite B crônica
More DifferentialsGuidelines
- ACR appropriateness criteria: abnormal liver function tests
- Clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis
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