Hepatitis - autoimmune
Description
- Chronic interface hepatitis with autoantibodies + hypergammaglobulinaemia, responsive to immunosuppression
- The triad: inc AST/ALT + liver autoantibodies + inc IgG
| Type 1 | Type 2 | |
|---|---|---|
| Antibodies | ANA, ASMA, anti-actin, anti-SLA/LP, +/- ANCA | Anti-LKM-1 (or LKM-3), anti-LC1 |
| Age | Any; bimodal (adolescent + 40-60) | Children/young adults |
| Course | Variable | More severe, more often cirrhotic at diagnosis, relapse on withdrawal |
| IgG | Raised | May be normal; IgA deficiency common |
- Anti-SLA/LP - most specific for AIH; predicts relapse and need for long-term therapy
- AMA suggests overlap with PBC
- Seronegative AIH ~10-20% - absence of antibodies does not exclude it
Overlap syndromes
- AIH-PBC (AMA+, cholestatic LFTs, florid duct lesions)
- AIH-PSC - younger patients, IBD; do MRCP if cholestatic or IBD present
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