Overview
Autoimmune hepatitis is a liver condition where the body's immune system mistakenly attacks liver cells, causing chronic inflammation and damage. The exact cause of autoimmune hepatitis is not clear, but genetic and environmental factors are thought to contribute. If left untreated, autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and liver failure. However, with early diagnosis and treatment, the disease can often be controlled using medications that suppress the immune system. In some cases, a liver transplant may be necessary. Symptoms vary from person to person and can include fatigue, abdominal discomfort, yellowing of the skin and whites of the eyes (jaundice), enlarged liver, abnormal blood vessels on the skin (spider angiomas), skin rashes, joint pains, loss of menstrual periods, and others. It is important to see a doctor if you have any concerning signs or symptoms.
Understanding the disease
Symptoms
Symptoms of autoimmune hepatitis can vary from person to person and may include fatigue, abdominal discomfort, yellowing of the skin and whites of the eyes (jaundice), an enlarged liver, abnormal blood vessels on the skin (spider angiomas), skin rashes, joint pains, loss of menstrual periods, and confusion, drowsiness, or slurred speech. If you experience any of these symptoms, it's important to consult with your health care provider.
Risk Factors
Risk factors for developing autoimmune hepatitis include being female, having a history of certain infections such as measles, herpes simplex, or Epstein-Barr virus, and having other autoimmune diseases such as celiac disease, rheumatoid arthritis, or ulcerative colitis.
Development
Autoimmune hepatitis develops when the body's immune system, which normally attacks viruses, bacteria, and other pathogens, mistakenly targets liver cells. This leads to chronic inflammation and damage to liver cells. The exact cause of autoimmune hepatitis is not clear, but it is believed to be the result of a combination of genetic and environmental factors. There are two main forms of autoimmune hepatitis: Type 1 and Type 2. Type 1 is the most common and can occur at any age, with around half of the people having other autoimmune disorders. Type 2 is more common in children and young people, and may also be associated with other autoimmune diseases. Risk factors for developing autoimmune hepatitis include being female, having a history of certain infections, and having an autoimmune disease. Untreated autoimmune hepatitis can lead to complications such as cirrhosis and liver failure, but when diagnosed and treated early, the disease can often be controlled with drugs that suppress the immune system. In cases where the disease does not respond to drug treatments or there is advanced liver disease, a liver transplant may be an option.
Assessment and Diagnosis
Triage
You should see a doctor if you have any signs or symptoms that worry you, especially if they include fatigue, abdominal discomfort, yellowing of the skin and whites of the eyes (jaundice), an enlarged liver, abnormal blood vessels on the skin (spider angiomas), skin rashes, joint pains, loss of menstrual periods, loss of appetite, nausea, vomiting, abdominal tenderness, or fever. These symptoms may indicate autoimmune hepatitis, and a doctor can help diagnose and treat the condition accordingly.
Diagnosis
The diagnosis of autoimmune hepatitis involves a combination of blood tests and a liver biopsy. Blood tests are used to detect the presence of antibodies, which can help distinguish autoimmune hepatitis from other conditions with similar symptoms. Antibody tests can also identify the specific type of autoimmune hepatitis. A liver biopsy is performed to confirm the diagnosis and determine the extent and type of liver damage. In this procedure, a small amount of liver tissue is removed using a thin needle, and the sample is analyzed in a laboratory.
Management and Treatment
Complications
Autoimmune hepatitis that goes untreated can cause permanent scarring of the liver tissue (cirrhosis). Complications of cirrhosis include:
- Enlarged veins in your esophagus (esophageal varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels - mainly those in your stomach and esophagus. The blood vessels are thin walled, and because they're filled with more blood than they're meant to carry, they're likely to bleed. Massive bleeding in the esophagus or stomach from these blood vessels is a life-threatening emergency that requires immediate medical care.
Treatment
The treatments for autoimmune hepatitis include drugs that suppress the immune system. When diagnosed and treated early, autoimmune hepatitis can often be controlled with these drugs. If the disease does not respond to drug treatments or there is advanced liver disease, a liver transplant may be considered.
Preparing for medical consultation
To prepare for an appointment for autoimmune hepatitis, you should:
- Be aware of any pre-appointment restrictions: Ask when you schedule the appointment if there are any specific instructions you need to follow, such as fasting before a specific test.
- Write down any symptoms you're experiencing: Include any symptoms that may seem unrelated to autoimmune hepatitis.
- Write down key personal information: Prepare a list of major stresses, recent life changes, and family medical history.
- Make a list of all medications, vitamins, or supplements you're taking: This includes any prescription, over-the-counter, or herbal products.
- Bring a family member or friend along: Having someone with you can help you remember important information discussed during the appointment.
- Prepare questions to ask your doctor: Some basic questions to ask include the cause of your symptoms, necessary tests, the potential severity and chronicity of your condition, treatment options, potential side effects, and any dietary or lifestyle restrictions.
- Learn about your family's medical history: If possible, ask family members about any liver disease in your family. Remember to be open and honest with your doctor about your symptoms and concerns, and don't hesitate to ask any additional questions that may arise during the appointment.