What happens in the liver
In autoimmune hepatitis, immune cells perceive liver tissue as foreign and maintain constant inflammation. Dead cells are replaced by connective tissue, and over a long period of time, fibrosis is formed, and then cirrhosis with impaired organ function. It is not known exactly why the failure occurs: the role of hereditary predisposition and external triggers - previous infections and certain medications - are being discussed. The disease is often combined with other autoimmune conditions: thyroid disease, celiac disease, rheumatoid arthritis, inflammatory bowel disease.
- Immune attack on liver cells
- Chronic inflammation and death of hepatocytes
- Development of fibrosis and cirrhosis without treatment
- The role of heredity and external triggers
- Frequent combination with other autoimmune diseases
Symptoms
In some patients, the disease begins acutely and resembles viral hepatitis: weakness, nausea, lack of appetite, pain in the right hypochondrium, jaundice, dark urine. But more often the course is gradual, and the complaints are nonspecific: chronic fatigue, decreased performance, heaviness in the side, joint pain, itching, and in women, menstrual irregularities. In the later stages, signs of cirrhosis appear: abdominal enlargement due to fluid, swelling, spider veins on the skin, redness of the palms, bleeding. Sometimes the disease is detected accidentally by elevated liver enzymes.
- Severe fatigue and weakness
- Heaviness and pain in the right hypochondrium
- Joint pain
- Itchy skin
- Acute onset jaundice
- Menstrual irregularities
- Incidental finding of elevated ALT and AST
Diagnostics
The diagnosis consists of several components. Biochemistry reveals an increase in ALT and AST, often significant, sometimes together with bilirubin. A high level of immunoglobulin G is characteristic. Autoantibodies are determined: antinuclear, to smooth muscles, and in another type of disease - to microsomes of the liver and kidneys. Be sure to exclude viral hepatitis, drug and alcohol damage, and copper and iron metabolic diseases. A liver biopsy is necessary in many cases: it confirms the nature of the inflammation and shows the stage of fibrosis. Elastography helps assess liver density non-invasively.
- ALT, AST, bilirubin, albumin
- Immunoglobulin G
- Antinuclear antibodies and anti-smooth muscle antibodies
- Markers of viral hepatitis
- Liver ultrasound and elastography
- Liver biopsy
- Rule out Wilson's disease and hemochromatosis
Treatment
The goal of treatment is to suppress an excessive immune reaction and achieve normalization of enzymes and immunoglobulin G. The basis is glucocorticosteroids, to which a drug is usually added to reduce their dose and reduce side effects. The treatment is long-term, for years, the dose is gradually reduced under the control of tests. Self-cessation of medications when you feel better is the most common cause of exacerbations, therefore changes in the regimen are permissible only by the doctor’s decision. If standard therapy is ineffective, other immunosuppressive drugs are used, and in case of decompensated cirrhosis, liver transplantation is discussed.
- Glucocorticosteroids as the basis of therapy
- Additional immunosuppressive drug to reduce hormone dose
- Long-term treatment with gradual dose reduction
- Regular monitoring of ALT, AST and immunoglobulin G
- Prohibition on self-discontinuation of drugs
- Prevention of osteoporosis with long-term use of hormones
- Liver transplantation for decompensated cirrhosis
Living with a diagnosis
Autoimmune hepatitis requires constant monitoring, but does not mean giving up normal life. Regular visits to the doctor and tests at the appointed time, complete abstinence from alcohol, and caution with any new medications and dietary supplements are important. Vaccination against hepatitis A and B is recommended if there is no immunity. The food is ordinary, nutritious, without fashionable restrictions; When taking hormones, they monitor your weight, blood pressure, sugar levels and bone condition. Pregnancy is possible, but it needs to be planned together with a doctor, during a period of stable remission and with the selection of a safe regimen.
- Regular control of analyzes
- Complete abstinence from alcohol
- Caution with new drugs and dietary supplements
- Vaccination against hepatitis A and B
- Control of weight, blood pressure and sugar during hormone therapy
- Planning a pregnancy with your doctor
- Monitoring the condition of bone tissue