Autoimmune Hepatitis is defined as a necroinflammatory disease of the liver , unremarkably continuing and reformist , of not well known cause . This disease is characterized by the presence of immunologic modification , among which are hypergammaglobulinemia , the front of autoantibody and , broadly speaking , a good reaction to immunosuppressive handling . The clinical presentation is very variable , in the shape of keen disease , fulminant or , on the obstinate , asymptomatic or not very fighting .
What are the Causes of Autoimmune Hepatitis?
Currently the aetiology of the disease is unknown ; it is distrust that in genetically predispose individuals , some environmental agent trigger the immune arrangement against liver antigen , make chronic progressive kindling . No clear grounds has been find on which or what are the potential triggers of the immune response against own liver antigens .
These are the most implicated agents : viruses such as those of hepatitis A , B or C , Herpes Simplex Virus type I or measles computer virus , and different drug or environmental toxin , which can trip liver perniciousness by immunological mechanisms .
An important datum for the diagnosis of the disease is the presence of autoantibodies , although its pathogenic implication is not clear .
Autoimmune hepatitis has been classified into two subtypes taking into account these autoantibodies :
-Type 1 is associated with the bearing of antinuclear antibody ( ANA ) , anti - smooth muscleman antibodies ( ASMA ) or Antibodies against soluble liver antigen / liver - pancreas ( SLA / LP ) .
-Type 2 is associated with antibody against hepatorenal microsomes type 1 ( LKM-1 ) or against hepatic cytosolic protein ( LC1 ) .
For the diagnosis , biochemical and immunological criteria should be adopt into account . In add-on , a liver biopsy for histologic evaluation is considered very commodious and often required . Likewise , the reaction to immunosuppressive discourse represents an important symptomatic standard .
Clinical Parameters
The symptoms are non - specific in Autoimmune Hepatitis , so the attack can be subtle , with asthenia ( worldwide weakness ) , tartness ( yellowish color of the skin and mucous ) and arthralgias ( bother locate in the joints ) , but it is very frequent for the patient role to be asymptomatic ( absence of symptom ) and the diagnostic distrust is establish on the cursory spotting of alteration in biochemical parameter . However , presentment is also frequent in the mannequin of intense hepatitis , now and then severe or fulminating .
It predominates in the female sexual urge and in most cases occurs between 50 and 70 class of years . Its affiliation with other autoimmune disease is frequent , in the patient or in his first academic degree relatives .
Biochemical Parameters
They are also non - specific . Transaminase ( liver enzymes ) values can swan from normal values to concentrations greater than 50 clip the upper limit of normal , with variable bilirubin and little or no tiptop of alkaline phosphatase . Another feature film is the increase in da Gamma globulin and IgG.
Treatment with corticosteroids induces clinical and histological remission in 80 % of patients in the first 3 years of treatment and reduces or foreclose liver fibrosis in 79 % of display case .
The decision to treat patients with Autoinmmune Hepatitis is complicated due to the miscellany of clinical presentations of the disease , the lack of cognition of the rude account of temperate asymptomatic disease , the recommendations about the treatment objective lens , the existence of case of patients with intolerance or refractoriness to conventional discussion and the variety of immunosuppressive treatment alternative to formal treatment . Therefore , treatment decisions can be guide on but there are no established treatment guideline since each handling strategy must be individualize depending on the condition of each affected role .
Failure in treatment is defined as clinical , analytical and histological worsening despite treatment . The treatment consists of administering Prednisone in monotherapy at a dose of 60 magnesium / d or at a dose of 30 mg / d in combination with Azathioprine at a dose of 150 milligram / d for 4 - 6 weeks and subsequently reducing the dosage more and more each calendar month of clinical - analytical melioration up to a sustentation dose .
Conclusion
The movement of autoimmune hepatitis is not known , however , there is a certain genetic sensitivity to develop this disease . Sometimes it is potential to place a trigger factor of infective type that initiates the hepatic inflammatory process ; it fall out by hepatitis A computer virus . sure medications such as nitrofurantoin and Minocin can spark off an autoimmune hepatitis .
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