Autoimmune Hepatitis

The Liver

The liver is the body’s largest organ, located in the right upper abdomen, behind the ribs. It is very complex with many functions, including:

• Storing energy in the form of sugar (glucose)
• Storing vitamins, iron, and other minerals
• Making proteins, including blood clotting factors, to keep the body healthy and help it grow
• Processing worn out red blood cells
• Making bile which is needed for food digestion
• Metabolizing or breaking down many medications and alcohol
• Killing germs that enter the body through the intestine

The liver shoulders a heavy workload for the body, and almost never complains. It even has a remarkable power to regenerate itself. Still, you should not take it for granted. The liver is subject to illnesses that can lead to permanent damage. One example is Autoimmune Hepatitis, a condition in which the body fights against its own liver.

What ls Hepatitis?

When chemicals or infection injures the body’s cells, the wounded area becomes inflamed. Hepatitis is inflammation of the liver, which in turn causes damage to individual liver cells. Causes may include:

• Viral infection
• Alcohol
• Certain drugs
• Chemicals or poisons
• Other diseases

Hepatitis may be acute or chronic. In acute hepatitis, the inflammation develops quickly and lasts a short period. The patient usually recovers completely, but it can take up to several months.

Chronic hepatitis can develop over a number of years without the patient ever having acute hepatitis or even feeling sick. As the liver repairs itself, fibrous tissue develops, much like a scar forms after a cut or injury to the skin heals. Advanced scarring of the liver is called cirrhosis. Over time, cirrhosis irreversibly damages the liver, eventually ending in liver failure.

What is Autoimmune Hepatitis?

The immune system consists of different types of white blood cells that help to fight infections. Some of these cells produce antibodies that defend the body by destroying bacteria, viruses, and other foreign materials. However sometimes, the immune system mistakenly recognizes the body’s own organs as foreign. Autoimmune hepatitis occurs when the immune system attacks the liver in this way. Exactly what triggers the immune system against the liver is unknown. The inflammation is usually chronic, and without treatment, it can cause serious injury to the liver.

Symptoms and Diagnosis

Autoimmune hepatitis occurs about 70 percent of the time in adolescent or young adult women. However, older women and men may also develop the disease.

Early symptoms - same as those for most types of hepatitis:

• Fatigue
• Abdominal discomfort
• Aching joints

Severe symptoms - when autoimmune hepatitis progresses to severe cirrhosis

• Jaundice (yellow coloring to the skin and eyes)
• Marked swelling of the abdomen from fluid inside the abdomen
• Intestinal bleeding
• Mental confusion

Diagnostic Tests

• Blood testing can give a definite diagnosis of autoimmune hepatitis. 
• A liver biopsy will determine how much inflammation and scarring has developed. 

Treatment

Treatment of autoimmune hepatitis aims at curbing the autoimmune response and the damage to liver cells. It is most effective when begun at an early stage of the disease. In most cases, the initial treatment is with a cortisone drug, usually prednisone (trade names: Deltasone, Orasone). Sometimes a second drug, such as lmuran, may be added. When the patient no longer responds to treatment with medication and liver damage is severe, they may consider a liver transplant.

Liver Transplantation

Liver transplantation is now an accepted form of treatment for chronic, severe liver disease. Advances in surgical techniques and the use of new drugs to suppress rejection have dramatically improved the success rate of transplantation. The outcome for patients with autoimmune hepatitis is excellent. Survival rates for this condition at transplant centers are well over 90 percent, with a good quality of life after recovery.

This content was last medically reviewed in May 2022 by Sharlotte Manley, MSN, FNP, Erlanger Gastroenterology.