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How is autoimmune hepatitis diagnosed?

The doctor will make a diagnosis based on symptoms, blood tests, and a 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. Autoantibodies attack the body’s cells. In autoimmune hepatitis, the immune system makes one or more types of autoantibodies. The most common are antinuclear antibodies (ANA), smooth muscle antibodies (SMA), and antibodies to liver and kidney microsomes (anti-LKM). People with type 1 have ANA, SMA, or both, and people with type 2 have anti-LKM.
Blood tests also help distinguish autoimmune hepatitis from other diseases that resemble it, such as viral hepatitis B or C or a metabolic disease such as Wilson disease.
Liver biopsy. A tiny sample of liver tissue, examined with a microscope, can help doctors accurately diagnose autoimmune hepatitis and tell how serious it is. This procedure is done in a hospital or outpatient surgical facility.

How is autoimmune hepatitis treated?

Treatment works best when autoimmune hepatitis is diagnosed early. With proper treatment, autoimmune hepatitis can usually be controlled. In fact, studies show that sustained response to treatment stops the disease from getting worse and may reverse some of the damage.

The primary treatment is medicine to suppress, or slow down, an overactive immune system.

Autoimmune Hepatitis

By Howard J. Worman, M. D.

Autoimmune hepatitis is a condition in which the patient's own immune systems attacks the liver causing inflammation and liver cell death. The condition is chronic and progressive. Although the disease is chronic, many patients with autoimmune hepatitis present acutely ill with jaundice, fever and sometimes symptoms of severe hepatic dysfunction, a picture that resembles acute hepatitis.

Autoimmune hepatitis usually occurs in women (70 %) between the ages of 15 and 40. Although the term "lupoid" hepatitis was originally used to describe this disease, patients with systemic lupus erythematosus do not have an increased incidence of autoimmune hepatitis and the two diseases are distint entities. The patient will sometimes present with jaundice, fever and right upper quadrant pain and occasionally systemic symptoms such as arthralgias, myalgias, polyserositits and thrombocytopenia. Some patients will present with mild liver dysfunction and have only laboratory abnormalities as their initial presentation. Others will present with severe hepatic dysfunction.

Autoimmune hepatitis should be suspected in any young patient with hepatitis, especially those without risk factors for alcoholic, drug, metabolic or viral etiologies. 

Patients in whom a diagnosis of autoimmune hepatitis is suspected should have  (prednisone or pednisolone) and azathioprine (Imuran) is begun immediately. .

About two thirds to three quarters of patients with autoimmune hepatitis respond to treatment based on the return of serum ALT and AST activities to normal and an improved biopsy after several months. Some patients relapse as steroids and azathioprine doses are tapered or stopped and need chronic maintenance medications.  If end-stage liver disease develops, orthotopic liver transplantation is an effective procedure.

A very simple treatment of any type of hepatitis C or autoimmune Liver disease is by using Saffron, mix with water a piece the size of rice in a clay plate and drink the water in the morning, repeat for 15 days for full recovery.

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