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| Health Science |
| AUTOIMMUNE HEPATITIS |
Autoimmune hepatitis is a disease in which the body's
immune system attacks liver cells. This causes the liver to
become inflamed (hepatitis). Researchers think a genetic
factor may predispose some people to autoimmune diseases.
About 70 percent of those with autoimmune hepatitis are
women, most between the ages of 15 and 40.
The disease is usually quite serious and, if not treated, gets
worse over time. It's usually chronic, meaning it can last for
years, and can lead to cirrhosis (scarring and hardening) of
the liver and eventually liver failure.
Autoimmune hepatitis is classified as either type I or II. Type
I is the most common form in North America. It occurs at
any age and is more common among women than men.
About half of those with type I have other autoimmune
disorders, such as type 1 diabetes, proliferative
glomerulonephritis, thyroiditis, Graves' disease, Sjögren's
syndrome, autoimmune anemia, and ulcerative colitis. Type II
autoimmune hepatitis is less common, typically affecting girls
ages 2 to 14, although adults can have it too.
Autoimmune Disease
One job of the immune system is to protect the body from
viruses, bacteria, and other living organisms. Usually, the
immune system does not react against the body's own cells.
However, sometimes it mistakenly attacks the cells it is
supposed to protect. This response is called autoimmunity.
Researchers speculate that certain bacteria, viruses, toxins,
and drugs trigger an autoimmune response in people who
are genetically susceptible to developing an autoimmune
disorder.
Symptoms
Fatigue is probably the most common symptom of
autoimmune hepatitis. Other symptoms include
* enlarged liver
* jaundice
* itching
* skin rashes
* joint pain
* abdominal discomfort
* fatigue
* spider angiomas (abnormal blood vessels) on the skin
* nausea
* vomiting
* loss of appetite
* dark urine
* pale or gray colored stools
People in advanced stages of the disease are more likely to
have symptoms such as fluid in the abdomen (ascites) or
mental confusion. Women may stop having menstrual
periods.
Symptoms of autoimmune hepatitis range from mild to
severe. Because severe viral hepatitis or hepatitis caused by
a drug—for example, certain antibiotics—has the same
symptoms, tests may be needed for an exact diagnosis.
Your doctor should also review and rule out all your
medicines before diagnosing autoimmune hepatitis.
Diagnosis
Your doctor will make a diagnosis based on your symptoms,
blood tests, and liver biopsy.
* Blood tests. A routine blood test for liver enzymes can
help reveal a pattern typical of hepatitis, but further tests,
especially for autoantibodies, are needed to diagnose
autoimmune hepatitis. Antibodies are proteins made by the
immune system to fight off bacteria and viruses. In
autoimmune hepatitis, the immune system makes antinuclear
antibodies (ANA), antibodies against smooth muscle cells
(SMA), or liver and kidney microsomes (anti-LKM). The
pattern and level of these antibodies help define the type of
autoimmune hepatitis (type I or type II).
Blood tests also help distinguish autoimmune hepatitis from
viral hepatitis (such as hepatitis B or C) or a metabolic
disease (such as Wilson's disease).
* Liver biopsy. A tiny sample of your liver tissue, examined
under a microscope, can help your doctor accurately
diagnose autoimmune hepatitis and tell how serious it is. You
will go to a hospital or outpatient surgical facility for this
procedure.
Treatment
Treatment works best when autoimmune hepatitis is
diagnosed early. With proper treatment, autoimmune
hepatitis can usually be controlled. In fact, recent studies
show that sustained response to treatment not only stops
the disease from getting worse, but also may actually
reverse some of the damage.
The primary treatment is medicine to suppress (slow down)
an overactive immune system.
Both types of autoimmune hepatitis are treated with daily
doses of a corticosteroid called prednisone. Your doctor may
start you on a high dose (20 to 60 mg per day) and lower
the dose to 5 to 15 mg/day as the disease is controlled. The
goal is to find the lowest possible dose that will control your
disease.
Another medicine, azathioprine (Imuran) is also used to treat
autoimmune hepatitis. Like prednisone, azathioprine
suppresses the immune system, but in a different way. It
helps lower the dose of prednisone needed, thereby reducing
its side effects. Your doctor may prescribe azathioprine, in
addition to prednisone, once your disease is under control.
Most people will need to take prednisone, with or without
azathioprine, for years. Some people take it for life.
Corticosteroids may slow down the disease, but everyone is
different. In about one out of every three people, treatment
can eventually be stopped. After stopping, it is important to
carefully monitor your condition and promptly report any
new symptoms to your doctor because the disease may
return and be even more severe, especially during the first
few months after stopping treatment.
In about 7 out of 10 people, the disease goes into
remission, with a lessening of severity of symptoms, within 2
years of starting treatment. A portion of persons with a
remission will see the disease return within 3 years, so
treatment may be necessary on and off for years, if not for
life.
Side Effects
Both prednisone and azathioprine have side effects. Because
high doses of prednisone are needed to control autoimmune
hepatitis, managing side effects is very important. However,
most side effects appear only after a long period of time.
Some possible side effects of prednisone are
* weight gain
* anxiety and confusion
* thinning of the bones (osteoporosis)
* thinning of the hair and skin
* diabetes
* high blood pressure
* cataracts
* glaucoma
Azathioprine can lower your white blood cell count and
sometimes causes nausea and poor appetite. Rare side
effects are allergic reaction, liver damage, and pancreatitis
(inflammation of the pancreas gland with severe stomach
pain).
Other Treatments
People who do not respond to standard immune therapy or
who have severe side effects may benefit from other
immunosuppressive agents like mycophenylate mofetil,
cyclosporine or tacrolimus. People who progress to end
stage liver disease (liver failure) and/or cirrhosis may need a
liver transplant. Transplantation has a 1-year survival rate of
90 percent and a 5-year survival rate of 70 to 80 percent.
Content Credit NDDIC
immune system attacks liver cells. This causes the liver to
become inflamed (hepatitis). Researchers think a genetic
factor may predispose some people to autoimmune diseases.
About 70 percent of those with autoimmune hepatitis are
women, most between the ages of 15 and 40.
The disease is usually quite serious and, if not treated, gets
worse over time. It's usually chronic, meaning it can last for
years, and can lead to cirrhosis (scarring and hardening) of
the liver and eventually liver failure.
Autoimmune hepatitis is classified as either type I or II. Type
I is the most common form in North America. It occurs at
any age and is more common among women than men.
About half of those with type I have other autoimmune
disorders, such as type 1 diabetes, proliferative
glomerulonephritis, thyroiditis, Graves' disease, Sjögren's
syndrome, autoimmune anemia, and ulcerative colitis. Type II
autoimmune hepatitis is less common, typically affecting girls
ages 2 to 14, although adults can have it too.
Autoimmune Disease
One job of the immune system is to protect the body from
viruses, bacteria, and other living organisms. Usually, the
immune system does not react against the body's own cells.
However, sometimes it mistakenly attacks the cells it is
supposed to protect. This response is called autoimmunity.
Researchers speculate that certain bacteria, viruses, toxins,
and drugs trigger an autoimmune response in people who
are genetically susceptible to developing an autoimmune
disorder.
Symptoms
Fatigue is probably the most common symptom of
autoimmune hepatitis. Other symptoms include
* enlarged liver
* jaundice
* itching
* skin rashes
* joint pain
* abdominal discomfort
* fatigue
* spider angiomas (abnormal blood vessels) on the skin
* nausea
* vomiting
* loss of appetite
* dark urine
* pale or gray colored stools
People in advanced stages of the disease are more likely to
have symptoms such as fluid in the abdomen (ascites) or
mental confusion. Women may stop having menstrual
periods.
Symptoms of autoimmune hepatitis range from mild to
severe. Because severe viral hepatitis or hepatitis caused by
a drug—for example, certain antibiotics—has the same
symptoms, tests may be needed for an exact diagnosis.
Your doctor should also review and rule out all your
medicines before diagnosing autoimmune hepatitis.
Diagnosis
Your doctor will make a diagnosis based on your symptoms,
blood tests, and liver biopsy.
* Blood tests. A routine blood test for liver enzymes can
help reveal a pattern typical of hepatitis, but further tests,
especially for autoantibodies, are needed to diagnose
autoimmune hepatitis. Antibodies are proteins made by the
immune system to fight off bacteria and viruses. In
autoimmune hepatitis, the immune system makes antinuclear
antibodies (ANA), antibodies against smooth muscle cells
(SMA), or liver and kidney microsomes (anti-LKM). The
pattern and level of these antibodies help define the type of
autoimmune hepatitis (type I or type II).
Blood tests also help distinguish autoimmune hepatitis from
viral hepatitis (such as hepatitis B or C) or a metabolic
disease (such as Wilson's disease).
* Liver biopsy. A tiny sample of your liver tissue, examined
under a microscope, can help your doctor accurately
diagnose autoimmune hepatitis and tell how serious it is. You
will go to a hospital or outpatient surgical facility for this
procedure.
Treatment
Treatment works best when autoimmune hepatitis is
diagnosed early. With proper treatment, autoimmune
hepatitis can usually be controlled. In fact, recent studies
show that sustained response to treatment not only stops
the disease from getting worse, but also may actually
reverse some of the damage.
The primary treatment is medicine to suppress (slow down)
an overactive immune system.
Both types of autoimmune hepatitis are treated with daily
doses of a corticosteroid called prednisone. Your doctor may
start you on a high dose (20 to 60 mg per day) and lower
the dose to 5 to 15 mg/day as the disease is controlled. The
goal is to find the lowest possible dose that will control your
disease.
Another medicine, azathioprine (Imuran) is also used to treat
autoimmune hepatitis. Like prednisone, azathioprine
suppresses the immune system, but in a different way. It
helps lower the dose of prednisone needed, thereby reducing
its side effects. Your doctor may prescribe azathioprine, in
addition to prednisone, once your disease is under control.
Most people will need to take prednisone, with or without
azathioprine, for years. Some people take it for life.
Corticosteroids may slow down the disease, but everyone is
different. In about one out of every three people, treatment
can eventually be stopped. After stopping, it is important to
carefully monitor your condition and promptly report any
new symptoms to your doctor because the disease may
return and be even more severe, especially during the first
few months after stopping treatment.
In about 7 out of 10 people, the disease goes into
remission, with a lessening of severity of symptoms, within 2
years of starting treatment. A portion of persons with a
remission will see the disease return within 3 years, so
treatment may be necessary on and off for years, if not for
life.
Side Effects
Both prednisone and azathioprine have side effects. Because
high doses of prednisone are needed to control autoimmune
hepatitis, managing side effects is very important. However,
most side effects appear only after a long period of time.
Some possible side effects of prednisone are
* weight gain
* anxiety and confusion
* thinning of the bones (osteoporosis)
* thinning of the hair and skin
* diabetes
* high blood pressure
* cataracts
* glaucoma
Azathioprine can lower your white blood cell count and
sometimes causes nausea and poor appetite. Rare side
effects are allergic reaction, liver damage, and pancreatitis
(inflammation of the pancreas gland with severe stomach
pain).
Other Treatments
People who do not respond to standard immune therapy or
who have severe side effects may benefit from other
immunosuppressive agents like mycophenylate mofetil,
cyclosporine or tacrolimus. People who progress to end
stage liver disease (liver failure) and/or cirrhosis may need a
liver transplant. Transplantation has a 1-year survival rate of
90 percent and a 5-year survival rate of 70 to 80 percent.
Content Credit NDDIC
| MEDICAL NOTES |
DISEASES AND
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo