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__NOTOC__
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{{Autoimmune hepatitis}}
{{Autoimmune hepatitis}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}:{{MKK}}


==Overview==
==Overview==
The majority of patients with [disease name] are asymptomatic.
Patient with [[autoimmune hepatitis]] presents asymptomatic or with symptoms of [[acute liver failure]]. A positive history of [[viral infections]] like [[hepatitis A]], C, and drug intake like [[minocycline]], [[interferon]] α, [[nitrofurantoin]], [[infliximab]], [[ezetimibe]], [[interferon]] β, [[ornidazole]], [[diclofenac]], [[indomethacin]], [[terbinafine]], [[methyldopa]], [[ranitidine]], [[atorvastatin]], [[fluvastatin]], [[fibrates]], [[adalimumab]] is suggestive of [[autoimmune hepatitis]]. The common symptoms of autoimmune hepatitis include [[jaundice]], [[fatigue]], and  [[abdominal discomfort]]. Less common symptoms of autoimmune hepatitis include [[acne]], [[edema]], [[hirsutism]], [[amenorrhea]].


OR
==History==
*The majority of patients with [[autoimmune hepatitis]] are initially asymptomatic but leads to severe symptoms and progresses even to [[fulminant hepatitis]].
*Autoimmune hepatitis can present as acute [[hepatitis]], [[chronic hepatitis]], or well-established [[cirrhosis]]. Autoimmune hepatitis can rarely present as the [[fulminant hepatic failure]].
*The hallmark of autoimmune hepatitis is [[fatigue]] and [[jaundice]].
===Past Medical History===
*History of [[hepatitis]] A, hepatitis E, [[cytomegalovirus]], and [[Epstein Barr virus|Epstein–Barr virus]].
*History of hepatitis A vaccination.<ref name="pmid15888974">{{cite journal |vauthors=Nagasaki F, Ueno Y, Mano Y, Igarashi T, Yahagi K, Niitsuma H, Okamoto H, Shimosegawa T |title=A patient with clinical features of acute hepatitis E viral infection and autoimmune hepatitis |journal=Tohoku J. Exp. Med. |volume=206 |issue=2 |pages=173–9 |year=2005 |pmid=15888974 |doi= |url=}}</ref><ref name="pmid11446931">{{cite journal |vauthors=Castellote J, Güell E, Porta F |title=[Autoimmune hepatitis following cytomegalovirus infection] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=117 |issue=2 |pages=76 |year=2001 |pmid=11446931 |doi= |url=}}</ref><ref name="pmid9219819">{{cite journal |vauthors=Kamisako T, Tsubaki K, Adachi Y, Kamisato T |title=Autoimmune hepatitis after cytomegalovirus infection in a bone marrow-transplanted patient |journal=Am. J. Gastroenterol. |volume=92 |issue=7 |pages=1238–9 |year=1997 |pmid=9219819 |doi= |url=}}</ref><ref name="pmid7499793">{{cite journal |vauthors=Huppertz HI, Treichel U, Gassel AM, Jeschke R, Meyer zum Büschenfelde KH |title=Autoimmune hepatitis following hepatitis A virus infection |journal=J. Hepatol. |volume=23 |issue=2 |pages=204–8 |year=1995 |pmid=7499793 |doi= |url=}}</ref><ref name="pmid14871651">{{cite journal |vauthors=Vento S, Cainelli F |title=Is there a role for viruses in triggering autoimmune hepatitis? |journal=Autoimmun Rev |volume=3 |issue=1 |pages=61–9 |year=2004 |pmid=14871651 |doi=10.1016/S1568-9972(03)00053-3 |url=}}</ref>
===Medication History===
*Prior use of [[minocycline]], [[interferon]] α, [[nitrofurantoin]], [[infliximab]], [[ezetimibe]], [[interferon]] β, [[ornidazole]], [[diclofenac]], [[indomethacin]], [[terbinafine]], [[methyldopa]], [[ranitidine]], [[atorvastatin]], [[fluvastatin]], [[fibrates]], [[adalimumab]]  increases the risk of autoimmune hepatitis.<ref name="pmid21757447">{{cite journal |vauthors=Gleeson D, Heneghan MA |title=British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis |journal=Gut |volume=60 |issue=12 |pages=1611–29 |year=2011 |pmid=21757447 |doi=10.1136/gut.2010.235259 |url=}}</ref><ref name="pmid10852297">{{cite journal |vauthors=Colmegna I, Perandones CE, Chaves JG |title=Minocycline induced lupus and autoimmune hepatitis |journal=J. Rheumatol. |volume=27 |issue=6 |pages=1567–8 |year=2000 |pmid=10852297 |doi= |url=}}</ref><ref name="pmid7539390">{{cite journal |vauthors=Heathcote EJ |title=Autoimmune hepatitis and chronic hepatitis C: latent or initiated by interferon therapy? |journal=Gastroenterology |volume=108 |issue=6 |pages=1942–4 |year=1995 |pmid=7539390 |doi= |url=}}</ref><ref name="pmid16162908">{{cite journal |vauthors=Germano V, Picchianti Diamanti A, Baccano G, Natale E, Onetti Muda A, Priori R, Valesini G |title=Autoimmune hepatitis associated with infliximab in a patient with psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=64 |issue=10 |pages=1519–20 |year=2005 |pmid=16162908 |pmc=1755231 |doi=10.1136/ard.2004.032821 |url=}}</ref><ref name="pmid11026106">{{cite journal |vauthors=Goldstein NS, Bayati N, Silverman AL, Gordon SC |title=Minocycline as a cause of drug-induced autoimmune hepatitis. Report of four cases and comparison with autoimmune hepatitis |journal=Am. J. Clin. Pathol. |volume=114 |issue=4 |pages=591–8 |year=2000 |pmid=11026106 |doi=10.1309/KV2J-VX6Q-L95V-VDE4 |url=}}</ref>


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
==History and Symptoms==
*The majority of patients with Autoimmune hepatitis are asymptomatic leads to severe symptoms and progresses even to fulminant hepatitis
*The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
*Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. 
===History===
Patients with [disease name]] may have a positive history of:
*[History finding 1]
*[History finding 2]
*[History finding 3]
===Common Symptoms===
===Common Symptoms===
Common symptoms of Autoimmune hepatitis include:<ref name="pmid21760995">{{cite journal |vauthors=Makol A, Watt KD, Chowdhary VR |title=Autoimmune hepatitis: a review of current diagnosis and treatment |journal=Hepat Res Treat |volume=2011 |issue= |pages=390916 |year=2011 |pmid=21760995 |pmc=3132488 |doi=10.1155/2011/390916 |url=}}</ref>   
Common symptoms of autoimmune hepatitis include:<ref name="pmid21760995">{{cite journal |vauthors=Makol A, Watt KD, Chowdhary VR |title=Autoimmune hepatitis: a review of current diagnosis and treatment |journal=Hepat Res Treat |volume=2011 |issue= |pages=390916 |year=2011 |pmid=21760995 |pmc=3132488 |doi=10.1155/2011/390916 |url=}}</ref><ref name="pmid23033899">{{cite journal |vauthors=Kim BH, Kim YJ, Jeong SH, Tak WY, Ahn SH, Lee YJ, Jung EU, Lee JI, Yeon JE, Hwang JS, Um SH, Seo YS, Kim YS, Song BC, Kim JH, Jung YK, Park CK, Kim KA, Min HJ, Cho EY, Lee ES, Kwon SY, Chae HB, Kim DJ, Shin SR |title=Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: a nationwide, multicenter study |journal=J. Gastroenterol. Hepatol. |volume=28 |issue=1 |pages=128–34 |year=2013 |pmid=23033899 |doi=10.1111/j.1440-1746.2012.07292.x |url=}}</ref><ref name="pmid18084114">{{cite journal |vauthors=Miyake Y, Iwasaki Y, Takaki A, Kobashi H, Sakaguchi K, Shiratori Y |title=Clinical features of Japanese elderly patients with type 1 autoimmune hepatitis |journal=Intern. Med. |volume=46 |issue=24 |pages=1945–9 |year=2007 |pmid=18084114 |doi= |url=}}</ref><ref name="pmid16699618">{{cite journal |vauthors=Bellomo-Brandão MA, Costa-Pinto EA, De Tommaso AM, Hessel G |title=Clinical and biochemical features of autoimmune hepatitis in 36 pediatric patients |journal=Arq Gastroenterol |volume=43 |issue=1 |pages=45–9 |year=2006 |pmid=16699618 |doi=/S0004-28032006000100012 |url=}}</ref><ref name="pmid20821236">{{cite journal |vauthors=Yasui S, Fujiwara K, Yonemitsu Y, Oda S, Nakano M, Yokosuka O |title=Clinicopathological features of severe and fulminant forms of autoimmune hepatitis |journal=J. Gastroenterol. |volume=46 |issue=3 |pages=378–90 |year=2011 |pmid=20821236 |doi=10.1007/s00535-010-0316-3 |url=}}</ref>   
*Fatigue
*[[Fatigue]]
*Lethargy
*[[Lethargy]]
*Upper abdominal discomfort
*[[Abdominal discomfort]]
*Mild pruritus
*Mild [[pruritus]]
*Anorexia
*[[Anorexia]]
*Myalgia
*[[Myalgia]]
*Diarrhea
*[[Diarrhea]]
*Arthralgias involving small joints
*[[Arthralgias]] involving small joints
*Dark urine  
*Dark [[urine]]
*Pale or gray-colored stools
*Pale or gray-colored [[stools]]
*skin rashes
*Skin rashes
*Weight loss
*[[Weight loss]]
 
===Less Common Symptoms===
===Less Common Symptoms===
Less common symptoms of Autoimmune hepatitis include :
Less common symptoms of autoimmune hepatitis include:
*Edema
*[[Edema]]
*Acne
*[[Acne]]
*Hirsutism
*[[Hirsutism]]
*Amenorrhea
*[[Amenorrhea]]
*Chest pain from pleuritis
*[[Chest pain]] from [[pleuritis]]
 
* Extrahepatic manifestations are generally due to the company that AH keeps:
:* [[Chronic autoimmune thyroiditis]]
:* [[Hyperthyroidism]] ([[Graves’ disease]])
:* [[Ulcerative colitis]]
:* [[Hemolytic anemia]]
:* [[Idiopathic thrombocytopenia]]
:* [[Diabetes mellitus]]
:* [[Diabetes insipidus]]
:* [[Celiac disease]]
:* [[Polymyositis]]
:* [[Myasthenia gravis]]
:* [[Pulmonary fibrosis]]
:* [[Pericarditis]]
:* [[Glomerulonephritis]]
:* [[pityriasis|Acute lichenoid pityriasis]]
:* [[panniculitis|Febrile panniculitis]]
:* [[Hypereosinophilic syndrome]]
:* [[Sjogren’s syndrome]]
:* [[Mixed connective tissue disease]]
* Although PSC is generally thought to be the liver disease most commonly associated with uterine contractions (UC), AH and UC often coexist, with the liver disease predating the colonic disease.
* AH is also associated with hepatocellular carcinoma, though many patients who eventually develop hepatocellular carcinoma have also been found to have hepatitis C.
* The LFT abnormalities are generally that of a marked transaminitis with a milder increase in Total bilirubin, alkalen phosphatase and [[PT]].
:* Some patients, however, have more of a cholestatic picture.
* Unfortunately, the symptoms and degree of enzyme abnormalities do not necessarily correlate with the pathology.
:* As above, however, most patients have at least some degree of cirrhosis at the time of initial biopsy.
* Hyperglobulinemia (usually gamma-globulin) is a characteristic feature of AH, though is not present in 100% of cases.
* Anti-actin antibodies are generally not tested for in most labs, despite the fact that they are more specific than the other tests for AH.
:* An anti-smooth muscle Ab titer > 1:320, however, is generally thought to reflect the presence of anti-actin antibodies.
* In the spectrum of autoimmune disease ranging from organ-specific to non-organ-specific, AH falls somewhere in the middle, as the disease is often confined to the liver, but the antibodies are mostly nonspecific.
* A scoring system has been developed by the International Autoimmune Hepatitis Group in order to facilitate the diagnosis.


==References==
==References==

Latest revision as of 01:09, 2 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: :Manpreet Kaur, MD [2]

Overview

Patient with autoimmune hepatitis presents asymptomatic or with symptoms of acute liver failure. A positive history of viral infections like hepatitis A, C, and drug intake like minocycline, interferon α, nitrofurantoin, infliximab, ezetimibe, interferon β, ornidazole, diclofenac, indomethacin, terbinafine, methyldopa, ranitidine, atorvastatin, fluvastatin, fibrates, adalimumab is suggestive of autoimmune hepatitis. The common symptoms of autoimmune hepatitis include jaundice, fatigue, and abdominal discomfort. Less common symptoms of autoimmune hepatitis include acne, edema, hirsutism, amenorrhea.

History

Past Medical History

Medication History

Common Symptoms

Common symptoms of autoimmune hepatitis include:[11][12][13][14][15]

Less Common Symptoms

Less common symptoms of autoimmune hepatitis include:

References

  1. ↑ Nagasaki F, Ueno Y, Mano Y, Igarashi T, Yahagi K, Niitsuma H, Okamoto H, Shimosegawa T (2005). "A patient with clinical features of acute hepatitis E viral infection and autoimmune hepatitis". Tohoku J. Exp. Med. 206 (2): 173–9. PMID 15888974.
  2. ↑ Castellote J, Güell E, Porta F (2001). "[Autoimmune hepatitis following cytomegalovirus infection]". Med Clin (Barc) (in Spanish; Castilian). 117 (2): 76. PMID 11446931.
  3. ↑ Kamisako T, Tsubaki K, Adachi Y, Kamisato T (1997). "Autoimmune hepatitis after cytomegalovirus infection in a bone marrow-transplanted patient". Am. J. Gastroenterol. 92 (7): 1238–9. PMID 9219819.
  4. ↑ Huppertz HI, Treichel U, Gassel AM, Jeschke R, Meyer zum Büschenfelde KH (1995). "Autoimmune hepatitis following hepatitis A virus infection". J. Hepatol. 23 (2): 204–8. PMID 7499793.
  5. ↑ Vento S, Cainelli F (2004). "Is there a role for viruses in triggering autoimmune hepatitis?". Autoimmun Rev. 3 (1): 61–9. doi:10.1016/S1568-9972(03)00053-3. PMID 14871651.
  6. ↑ Gleeson D, Heneghan MA (2011). "British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis". Gut. 60 (12): 1611–29. doi:10.1136/gut.2010.235259. PMID 21757447.
  7. ↑ Colmegna I, Perandones CE, Chaves JG (2000). "Minocycline induced lupus and autoimmune hepatitis". J. Rheumatol. 27 (6): 1567–8. PMID 10852297.
  8. ↑ Heathcote EJ (1995). "Autoimmune hepatitis and chronic hepatitis C: latent or initiated by interferon therapy?". Gastroenterology. 108 (6): 1942–4. PMID 7539390.
  9. ↑ Germano V, Picchianti Diamanti A, Baccano G, Natale E, Onetti Muda A, Priori R, Valesini G (2005). "Autoimmune hepatitis associated with infliximab in a patient with psoriatic arthritis". Ann. Rheum. Dis. 64 (10): 1519–20. doi:10.1136/ard.2004.032821. PMC 1755231. PMID 16162908.
  10. ↑ Goldstein NS, Bayati N, Silverman AL, Gordon SC (2000). "Minocycline as a cause of drug-induced autoimmune hepatitis. Report of four cases and comparison with autoimmune hepatitis". Am. J. Clin. Pathol. 114 (4): 591–8. doi:10.1309/KV2J-VX6Q-L95V-VDE4. PMID 11026106.
  11. ↑ Makol A, Watt KD, Chowdhary VR (2011). "Autoimmune hepatitis: a review of current diagnosis and treatment". Hepat Res Treat. 2011: 390916. doi:10.1155/2011/390916. PMC 3132488. PMID 21760995.
  12. ↑ Kim BH, Kim YJ, Jeong SH, Tak WY, Ahn SH, Lee YJ, Jung EU, Lee JI, Yeon JE, Hwang JS, Um SH, Seo YS, Kim YS, Song BC, Kim JH, Jung YK, Park CK, Kim KA, Min HJ, Cho EY, Lee ES, Kwon SY, Chae HB, Kim DJ, Shin SR (2013). "Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: a nationwide, multicenter study". J. Gastroenterol. Hepatol. 28 (1): 128–34. doi:10.1111/j.1440-1746.2012.07292.x. PMID 23033899.
  13. ↑ Miyake Y, Iwasaki Y, Takaki A, Kobashi H, Sakaguchi K, Shiratori Y (2007). "Clinical features of Japanese elderly patients with type 1 autoimmune hepatitis". Intern. Med. 46 (24): 1945–9. PMID 18084114.
  14. ↑ Bellomo-Brandão MA, Costa-Pinto EA, De Tommaso AM, Hessel G (2006). "Clinical and biochemical features of autoimmune hepatitis in 36 pediatric patients". Arq Gastroenterol. 43 (1): 45–9. doi:/S0004-28032006000100012 Check |doi= value (help). PMID 16699618.
  15. ↑ Yasui S, Fujiwara K, Yonemitsu Y, Oda S, Nakano M, Yokosuka O (2011). "Clinicopathological features of severe and fulminant forms of autoimmune hepatitis". J. Gastroenterol. 46 (3): 378–90. doi:10.1007/s00535-010-0316-3. PMID 20821236.

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