A progressive inflammatory hepatopathy
Several factors (eg, viral infection, drugs, environmental agents) may trigger an autoimmune response and autoimmune disease.
In a few patients with AIH, illness onset follows acute hepatitis A, hepatitis B, or Epstein-Barr virus infections.
Autoantibodies - in patients with chronic HCV infection, liver-kidney microsomal type 1 (LKM-1) antibody.
HLA status affects treatment outcome
aplastic anemia pediatrics
It compromises a group of disorders of the hematopoietic stem cells resulting in the suppression of one or more of erythroid, myeloid and megakaryotic cell lines.
thrombocytopenia
aplastic anemia pediatrics
It compromises a group of disorders of the hematopoietic stem cells resulting in the suppression of one or more of erythroid, myeloid and megakaryotic cell lines.
thrombocytopenia
Crimson Publishers: Dietary Supplements as a Possible Trigger of Autoimmune H...CrimsonGastroenterology
Introduction: Autoimmune hepatitis (AIH) etiology remains unknown, but in genetically predisposed individuals, diverse agents may trigger the disease. Herbal and drug induced AIH have been reported in recent years probable due to the increase in self-medication. More studies are necessary to define if drugs and herbal/dietary supplements unmask and induce AIH or drug-induced hepatitis with autoimmune features.
Purpose: We report an autoimmune hepatitis case possibly induced by herbal/dietary supplements intake.
Case-report: A 55-year-old female presented with a 15-day course of jaundice and increased aminotransferases. Immunologic panel showed antinuclear antibody titer of 1:320 and serum immunoglobulin G (IgG) level approximately 2 times the upper limit of normal. She reported regular daily ingestion of Herbalife® products for 6 months which were discontinued when symptoms began. Laboratory tests worsened despite the fact that patient had stopped supplements usage, and a liver biopsy was performed. Histology was suggestive of both AIH and drug induced liver disease. The patient fulfilled criteria for probable AIH based on the revised criteria for diagnosing autoimmune hepatitis, and improved with prednisolone and azathioprine therapy, with progressive laboratory improvement and symptoms remission.
Discussion: Herbal/dietary supplements induced AIH has been previously reported, but the causality is not yet well established. Worsening of aminotransferases despite supplement suspension, histological findings and favorable response with corticosteroid treatment, supported the hypothesis of AIH induced by the used supplement. This case report aims to demonstrate the possible causality between herbal/dietary supplements and liver injury, including autoimmune hepatitis.
A lysosomal storage disease caused by acid sphingomyelinase deficiency (ASMD), which catalyzes the hydrolysis of sphingomyelin (SM) to ceramide and phosphocholine.
Most pNENs - sporadical.
Some individuals may have a genetic predisposition to developing pNENs.
But may not be expressed unless it is triggered or activated under certain circumstances, such as due to certain environmental factors.
As part of a larger genetic syndrome such as; 1. Multiple endocrine neoplasia type I (MEN1), 2. Von Hippel-Lindau syndrome (VHL) or 3. Neurofibromatosis type I (NF-1).
Scleroderma is a group of autoimmune diseases that may result in changes to the skin, blood vessels, muscles, and internal organs.
The disease can be either localized to the skin or involve other organs in addition to the skin.
Symptoms may include areas of thickened skin, stiffness, feeling tired, and poor blood flow to the fingers or toes with cold exposure.
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome.
Characterised by numbness and tingling of the radial 3 ½ digits.
Found in 1% of the general population
Increased incidence is noted in women, the elderly and pregnant patients.
1. Undescended Testis : Along the normal path, but not reached scrotum.
2. Retractile Testis : Hyperreflexic Cremaster
3. Ectopic Testis : Deviation from normal path of descent
Absence of testis in scrotum since birth
Hemiscrotum empty, hypoplastic
Decreased caliber and force of the stream
Problems starting(hesitancy) and stopping urine stream; post-void dribbling
Impaired bladder emptying
- high risk of infection and hydronephrosis
Urinary retention
Incontinence
Nocturia; polyuria / Dysuria
Hypertrophy of bladder wall muscle
- increased risk for bladder diverticula
Microscopic hematuria maybe present
Scorpions are a common arthropod found all over the world.
If threatened, a scorpion may use its long, flexible tail to sting a potential predator.
Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Pediatric Autoimmune Hepatitis - Rivin
1. Pediatric
Autoimmune Hepatitis
W. P. Rivindu H. Wickramanayake
Group no. 04a
6th Year 1st Semester – 2020 April
Tbilisi State Medical University, Georgia
2. ● A progressive inflammatory hepatopathy.
● The most typical features of AIH are
- Female preponderance,
- Hypergammaglobulinemia/increased immunoglobulin G (IgG),
- Seropositivity for circulating autoantibodies, and
- A picture of interface hepatitis on histology.
● AIH responds to immunosuppressive treatment in the majority of cases.
Treatment should be instituted promptly upon diagnosis.
● If left untreated, AIH usually progresses to liver failure requiring
transplantation.
● Two types of AIH are distinguished according to serological profile:
- Type 1 AIH (AIH-1) - ANA and/or anti-smith muscle antibody (SMA),
- Type 2 AIH (AIH-2) - anti-liver kidney microsomal type 1
antibody(anti-LKM-1) and/or for anti-liver cytosol type 1 antibody (anti-LC-1).
3. ● Is unknown. Several factors (eg, viral infection, drugs,
environmental agents) may trigger an autoimmune response and
autoimmune disease.
● In a few patients with AIH, illness onset follows acute hepatitis
A, hepatitis B, or Epstein-Barr virus infections.
● Autoantibodies - in patients with chronic HCV infection, liver-
kidney microsomal type 1 (LKM-1) antibody.
Etiology
4. ● Some cases of drug-induced liver disease have an immune-
mediated basis. A number of drugs (eg, methyldopa,
nitrofurantoin, minocycline, adalimumab, infliximab) can
produce an illness with the clinical features of AIH.
● Although most cases improve when the drug is stopped,
chronic cases of AIH may be seen, even after drug withdrawal.
● Casswall et al found Helicobacter species DNA in 50% of liver
biopsies from patients with AIH and ulcerative colitis.
5. ● Current evidence suggests that liver injury in a patient with
autoimmune hepatitis is the result of a cell-mediated immunologic
attack.
● Aberrant display of human leukocyte antigen (HLA) class II on the
surface of hepatocytes facilitates the exposure of normal liver cell
membrane constituents to antigen-presenting cells (APCs).
● and helper T lymphocytes interact at the ligand-ligand level, which, in
turn, activates TH 0. This activation is followed by functional
differentiation into helper T cell 1(TH1)/ helper T cell 2(TH2), according
to the cytokines prevailing in the tissue & the nature of the antigen.
Pathogenesis
6. ● TH 1 primarily secretes interleukin 2 (IL-2) and interferon gamma,
which activate macrophages and enhance the expression of HLA
classes I and II, thus perpetuating the immune recognition cycle.
● TH 2 cells primarily produce interleukins 4, 5, and 10, which
stimulate autoantibody production by B lymphocytes.
● The asialoglycoprotein receptor and the cytochrome mono-
oxygenase P-450 IID6 are proposed as the triggering autoantigens.
● Physiologically, TH 1 and TH 2 cells antagonize each other.
Regulatory mechanisms strictly control the autoantigen recognition
process; their failure perpetuates an autoimmune attack.
7. ●Liver cell injury can be caused by the action of cytotoxic lymphocytes
that are stimulated by IL-2, complement activation, engagement of
natural killer lymphocytes by the autoantibody bound to the hepatocyte
surface, or reaction of autoantibodies with liver-specific antigens
expressed on hepatocyte surfaces.
●Autoantibody-coated hepatocytes from patients with autoimmune
hepatitis are killed when incubated with autologous allogenic
lymphocytes.
●The effector cell was shown to be an Fc receptor-positive mononuclear
cell.
●It is shown that T-cell clones from liver biopsy specimens in children
with autoimmune hepatitis who express the γ/δ T-cell receptor are
preferentially cytotoxic to liver-derived cells.
8. Epidemiology
● Prevalence in Europe - 11.6-16.9 cases per 100,000 persons.
- most common in whites of northern European ancestry
- with a high frequency of HLA-DR3 and HLA-DR4 markers.
● Prevalence in Japan - 0.08-0.015 cases per 100,000 persons.
- More associated with HLA-DR4.
● Women > Men (70%-80% of patients are women).
● AIH has a bimodal age distribution, with a first peak of incidence
at age 10-20 years and a second at age 45-70 years.
● Approx. one half of the affected individuals are younger than 20
years;
● Incidence peaks in premenstrual girls.
● Patients with AIH-2 tend to be younger; 80% are children.
11. Pediatric Presentation
● An acute presentation of mimicking acute viral hepatitis (ie,
abdominal discomfort, vomiting, nausea, jaundice).
● Fulminant hepatic failure - more common in patients with AIH-2.
● Insidious presentation was characterized by intermittent jaundice or
nonspecific symptoms.
● Routine blood analysis - abnormal liver enzymes.
● Patients with autoimmune hepatitis developed cirrhosis and portal
hypertension.
● AIH-2 can be part of autoimmune polyendocrinopathy-candidiasis-
ectodermal dystrophy (APECED), an autosomal recessive genetic
disorder in which liver disease is reportedly present in about 20% of
cases.
12. ● Often occur in children with AIH.
● In children with AIH-1:
- Ulcerative colitis
- Sclerosing cholangitis
- Vasculitis
- Arthritis
- Glomerulonephritis
- Diabetes mellitus
Additional Autoimmune Disorders
13. ●In children with AIH-2 :
- Polyendocrinopathy
- Alopecia areata
- Diabetes mellitus
- Thyroiditis
●Acute liver failure occurs primarily between the ages of 13 months
and 4 years in children with AIH-2.
●It typically occurs after puberty in patients with AIH-1.
14. ● Common findings on physical examination are as follows:
- Hepatomegaly
- Jaundice
- Splenomegaly
- Spider angiomata
- Ascites
- Encephalopathy
● All of these findings may be observed in patients with disease that has
progressed to cirrhosis with ensuing portal hypertension.
● However, hepatomegaly, jaundice, splenomegaly, and spider
angiomata also may be observed in patients who do not have cirrhosis.
15. ● Cirrhosis and complications of cirrhosis;
- Ascites,
- Coagulopathy,
- Hepatic coma
● Portal hypertension
● Esophageal varices
● Malnutrition (with poor growth in children)
● Overlap Syndrome[Tx. - Ursodiol + Immunosuppressants]
Complications
16. ● Many causes of chronic liver diseases including;
- α1 -antitrypsin deficiency,
- Wilson disease,
- Viral hepatitis,
- Hepatotoxic drugs,
- Excessive alcohol consumption
- Autoimmune polyendocrine syndrome type I (APS-1),
- Autoimmunity in hepatitis C virus (HCV) infection,
- Immune-mediated drug-induced hepatitis,,
- Cryptogenic hepatitis,
- Overlap syndrome [primary biliary cirrhosis (PBC)
and primary sclerosing cholangitis (PSC)]
Differential Diagnoses
17. Diagnosis
● Laboratory findings in autoimmune hepatitis include the following:
- Elevated serum aminotransferase levels (1.5-50 times
reference values)
- Elevated serum immunoglobulin levels, primarily
immunoglobulin G (IgG)
- Seropositive results for ANAs, SMAs, or LKM-1 or anti–
liver cytosol 1 (anti-LC1) antibodies
- Decreased albumin levels
- Prolonged prothombin time
● Urgent liver biopsy, transjugular if appropriate, may help to
confirm the clinical suspicion of autoimmune hepatitis.
19. ● Hematologic abnormalities may include the following:
- Mild leukopenia
- Normochromic anemia
- Coombs-positive hemolytic anemia
- Thrombocytopenia
- Elevated erythrocyte sedimentation rate
● Autoimmune hepatitis has even been described as the sole
presenting feature of idiopathic hypereosinophilic syndrome.
20. ● The presence of heterogeneous hepatic echotexture on abdominal
ultrasound or abnormal contrast enhancement on abdominal CT
imaging may suggest the presence of active inflammation or
necrosis.
● The appearance of an irregular nodular liver may confirm the
presence of cirrhosis.
● Endoscopic retrograde cholangiopancreatography (ERCP) to rule
out coexisting primary sclerosing cholangitis (PSC) [When alkaline
phosphatase levels are 7-8 times reference values or gamma glutamyl
transferase levels are 2-3 times reference values + a patient with autoimmune
hepatitis and ulcerative colitis]
25. ● Prednisolone rather than prednisone may be used, at a dosage of 2
mg/kg/d (not to exceed 60 mg/d).
● Taper over 4-8 weeks, if testing of transaminase levels
demonstrates gradual improvement, then administer the minimum
maintenance dose required to sustain reference levels of liver
enzymes.
● If liver enzyme levels do not return to the reference values during
the first 4-8 weeks of treatment or if improvement requires high
doses of steroids, initiate azathioprine administration at 0.5 mg/kg/d
and gradually increase to 2 mg/kg/d until transaminase levels return
to the reference values.
26. ● An effective form of therapy for patients in whom medical therapy
has failed, or those with decompensated cirrhosis caused by AIH.
● Liver transplantation also may be used to rescue patients who
present with fulminant hepatic failure secondary to AIH.
● Approximately 10%-20% of patients require liver transplantation.
● The long-term outlook after liver transplantation is excellent, with
10-year survival rates reported as greater than 70%.
● Positive autoantibodies and hypergammaglobulinemia tend to
disappear within 2 years of transplantation.
Liver Transplantation
27. ● Should perform liver function tests in patients with autoimmune
hepatitis (AIH) weekly during the first 6-8 weeks of treatment
and then every 2-3 months, based on the results.
● Scheduling regular follow-up visits to assess disease activity
and to search for signs and symptoms of chronic liver disease.
● Surveillance abdominal imaging studies (eg, ultrasound, CT,
MRI) and alpha-fetoprotein testing are typically performed
every 6 months in patients with most types of cirrhosis.
Long-Term Monitoring
28. Prognosis
● In children with AIH, 70% require treatment until adulthood.
● Many patients already have cirrhosis at the time of diagnosis.
● Almost 20-25% of children with Autoimmune hepatitis die or
require liver transplantation.
● Young patients with AIH should receive immunosuppressive
treatment to prevent or delay cirrhosis, even if they do not meet other
treatment criteria.
29. ● HLA status affects treatment outcome.
Eg. - HLA DR3-positive patients - active disease & less
responsive to therapy than patients with other HLA types & require
liver transplantation.
● Spontaneous resolution in 13%-20% of patients, regardless of the
inflammatory activity, an unpredictable event.
● In general, the following factors are associated with a worse
prognosis:
• Young age at presentation
• AIH-2
• Coagulopathy
• Severe initial histologic activity
30. Questions
1. Which one of the following statements regarding AIH is true?
1. An acute onset of illness is common (40%)- TRUE
2. Women are affected more than men (M: F- 1:2)
3. Predominant serum alkaline phosphatase abnormality
4. Immunoglobulin level is usually normal
5. Splenomegaly and spider naevi never occurs in absence of cirrhosis
2. Which one of the following statements regarding AIH is/are true?
1. Auto antibodies at least in 1:80 titres in adults- ANA, SMA or LKM1 and no
AMA
2. Bilirubin >4fold increase is unusual
3. Anti-LKM1 typically occurs in the absence of SMA and ANA
4. Bridging necrosis is an indication of treatment
5. All above
31. 3. Which one of the following statements regarding AIH is false?
1. Relapse is characterized by an increase in the serum aminotransferase level to more
than 3-fold the upper limit of normal and/or increase in the serum gamma-globulin level to
more than 2 g/dL
2. Indefinite low dose treatment is given after second relapse
3. Relapse occurs in from 20% to 100% of patients who enter remission.
4. After first relapse long term treatment is needed
5. Biochemical remission means serum aminotransferase levels to less than twice
normal, restoration of serum bilirubin and gammaglobulin levels to normal
4. Which one of the following statements regarding AIH is false?
1. Both steroid only and steroid and azathioprine are approved treatment options
2. Adults rarely achieve remission in less than 12 months
3. Histologic improvement lags behind clinical and laboratory improvement by 3 to 6
months
4. Sixty-five percent of patients enter remission within 18 months
5. Biochemical remission is defined as serum aminotransferase to normal