advertisement

Autoimmune Hepatitis

53 %
47 %
advertisement
Information about Autoimmune Hepatitis

Published on April 3, 2008

Author: hanash

Source: slideshare.net

Description

overview on autoimmune hepatitis.
advertisement

Autoimmune Hepatitis diagnosis & management Dr E M Said

definition unresolving inflammation of the liver of unknown cause. Reflex a complex interaction between triggering factors,autoantigens,genetic predisposition and immunoregulatory network. Characterized by the presence of interface hepatitis & portal plasma cell infiltration in histological examination,hypergammaglobulinaemia and auto antibodies.

unresolving inflammation of the liver of unknown cause.

Reflex a complex interaction between triggering factors,autoantigens,genetic predisposition and immunoregulatory network.

Characterized by the presence of interface hepatitis & portal plasma cell infiltration in histological examination,hypergammaglobulinaemia and

auto antibodies.

 

epidemiology In northern Europeans Annual incidence 1.9/100,000 Prevalence 16.9/100,000 2.6% of liver transplant Female affected more than males gender ratio 3.6:1

In northern Europeans

Annual incidence 1.9/100,000

Prevalence 16.9/100,000

2.6% of liver transplant

Female affected more than males

gender ratio 3.6:1

40% of patient with untreated severe disease die within 6 month of diagnosis. of survivors 40% will develop cirrhosis, 54% will develop oesophageal varesis acute onset AIH is common 40%,and fulminant presentation with encephalopathy within 8 month is possible

40% of patient with untreated severe disease die within 6 month of diagnosis.

of survivors

40% will develop cirrhosis,

54% will develop oesophageal varesis

acute onset AIH is common 40%,and fulminant presentation with encephalopathy within 8 month is possible

classification 3 main subtypes Based on difference in their immunological markers. Not endorsed as a valid clinical entity by the international autoimmune hepatitis group

3 main subtypes

Based on difference in their immunological markers.

Not endorsed as a valid clinical entity by the international autoimmune hepatitis group

Type 1 AIH The most common form of the disease worldwide Associated with ANA and/or SMA Over 70% are female and over 40% younger age group.

The most common form of the disease worldwide

Associated with ANA and/or SMA

Over 70% are female and over 40% younger age group.

Type 2 AIH More common in Europe and south America. Associated with anti-LKM Described in paediatrics patient but in Europe 20% are adults

More common in Europe and south America.

Associated with anti-LKM

Described in paediatrics patient but in Europe 20% are adults

Type 3 AIH Is the least established form of the disease. Associated with anti-SLA/LP

Is the least established form of the disease.

Associated with anti-SLA/LP

Diagnostic criteria Diagnosis require presence of characteristics features & exclusion of other condition that resemble AIH All patients must be evaluated for hereditary, infectious and drug induced liver injury. Interface hepatitis is the histologic hall mark of the syndrome & portal plasma infiltration typifies the disorder, but neither are specific.

Diagnosis require presence of characteristics features & exclusion of other condition that resemble AIH

All patients must be evaluated for hereditary, infectious and drug induced liver injury.

Interface hepatitis is the histologic hall mark of the syndrome & portal plasma infiltration typifies the disorder, but neither are specific.

Interface hepatitis and bridging necrosis in severe type 1 autoimmune hepatitis

Plasma cell infiltration of the portal tracts in type 1 autoimmune hepatitis

The diagnosis of AIH require determination of aminotransferase and gamma globulins; detection of ANA and/or SMA or in their absence anti-LKM1,and liver tissue examination.

The diagnosis of AIH require determination of aminotransferase and gamma globulins; detection of ANA and/or SMA or in their absence anti-LKM1,and liver tissue examination.

Diagnostic criteria should be applied to all patients

If the diagnosis of AIH is not clear, scoring system should be used

treatment 3 RCT showed improve clinical,histological & survival of severe AIH after use of steroids No trial has been performed in patients with less severe disease. The indication for steroids treatment in patients with mild disease must be individualized and based on clinical judgment

3 RCT showed improve clinical,histological & survival of severe AIH after use of steroids

No trial has been performed in patients with less severe disease.

The indication for steroids treatment in patients with mild disease must be individualized and based on clinical judgment

Indications for treatment

Treatment regimens Two regimens comparable with each other and superior to NSAID's Prednisolone alone or lower dose of prednisolone in conjunction with azathioprine All patients should be monitored for the development of drug side effect

Two regimens comparable with each other and superior to NSAID's

Prednisolone alone or lower dose of prednisolone in conjunction with azathioprine

All patients should be monitored for the development of drug side effect

 

 

 

Treatment end point Conventional treatment regimens should be continued until remission,treatment failure,incomplete response or drug toxicity Once disease remission is achieved drug withdrawal should be attempted.

Conventional treatment regimens should be continued until remission,treatment failure,incomplete response or drug toxicity

Once disease remission is achieved drug withdrawal should be attempted.

 

relapse Relapse is common after drug withdrawal Patients should be monitored by serum aminotransferase ,bilirubin and gamma globulin level Two strategies are used in patients who relapse at least twice. Indefinite low dose prednisolone therapy Indefinite Azathioprine therapy

Relapse is common after drug withdrawal

Patients should be monitored by serum aminotransferase ,bilirubin and gamma globulin level

Two strategies are used in patients who relapse at least twice.

Indefinite low dose prednisolone therapy

Indefinite Azathioprine therapy

 

Treatment failure High dose prednisolone alone or in combination with azathioprine should be used in treatment failure Alternative management include administration of cyclosporine,methotrexate, 6-mercaptopurine or urodexycoliuc acid Liver transplantation should be considered in the decompansated patient who is unable to undergo of be salvaged by drug therapy

High dose prednisolone alone or in combination with azathioprine should be used in treatment failure

Alternative management include administration of cyclosporine,methotrexate, 6-mercaptopurine or urodexycoliuc acid

Liver transplantation should be considered in the decompansated patient who is unable to undergo of be salvaged by drug therapy

 

Thank you

Thank you

Add a comment

Related pages

Autoimmunhepatitis – Wikipedia

Autoimmune Hepatitis: ICD-10 online (WHO-Version 2016) Mikrofoto von Autoimmunhepatitis. HE-Färbung. Die Autoimmunhepatitis (AIH) ist eine seltene, akute ...
Read more

Autoimmune Hepatitis (AIH) - Patienteninformationen ...

Autoimmune Hepatitis (AIH) Die autoimmune Hepatitis ist durch einen chronisch verlaufenden Entzündungsprozess der Leber gekennzeichnet, bei dem ...
Read more

Autoimmunhepatitis (AIH) - Deutsche Leberhilfe e.V.

Nein, niemals. Autoimmunhepatitis ist ein Problem, das der Körper mit sich selbst hat. ("Hepatitis" heißt übersetzt nur "Leberentzündung", ...
Read more

Autoimmune Hepatitis

Autoimmune hepatitis is a chronic—or long lasting—disease in which the body's immune system attacks the normal components, or cells, of the liver and ...
Read more

Autoimmunhepatitis - DocCheck Flexikon

Typ 2: LKM1-positive autoimmune Hepatitis mit nachweisbaren LKM1-Antikörpern (ca. 20 %) Der Typ 2 tritt vornehmlich im Kindes- und Jugendalter auf.
Read more

Autoimmune hepatitis - Wikipedia, the free encyclopedia

Autoimmune hepatitis, formerly called lupoid hepatitis, is a chronic, autoimmune disease of the liver that occurs when the body's immune system attacks ...
Read more

Overview - Autoimmune hepatitis - Mayo Clinic

Autoimmune hepatitis — Comprehensive overview covers symptoms, complications and treatment for this chronic liver disease.
Read more

Autoimmune Hepatitis : Forum Gesundheit - goFeminin

Autoimmune Hepatitis. Hallo! ich bin 26 Jahre alt und vor fast genau sechs Jahren wurde bei mir eine Autoimmune Hepatitis diagnostiziert. Seit dem nehme ...
Read more

Autoimmune Hepatitis | Hepatitis

Was ist autoimmune Hepatitis ? Autoimmun-Hepatitis ist eine Art von Leberentzündung, in denen die körpereigene Immunzellen angreifen gesunden Leberzellen ...
Read more

Autoimmune Hepatitis | Autoimmunhepatitis - Chronische ...

Die autoimmune Hepatitis ist eine chronische und entzündliche Autoimmunkrankheit der Leber. Die Krankheit befällt bevorzugt Frauen im Alter zwischen 20 ...
Read more