Autoimmune hepatitis (AZW) is a chronic, inflammatory disease of the liver parenchyma. If left untreated, it leads to liver destruction and, consequently, cirrhosis. Then, the only method of treatment and saving the patient's life is liver transplantation. What are the causes and symptoms of autoimmune hepatitis. How is AZW treated?

Autoimmune hepatitis (Autoimmune hepatitis ), abbreviatedAZW , is chronic, inflammatory disease of the liver parenchyma.

According to research, the disease occurs with a frequency of 0.1-1.9 cases per 100,000 inhabitants, the greater part of which are women, because they are affected 4 times more often than men. The disease is most often diagnosed in adolescence and from 40 to 60 years of age.

Autoimmune hepatitis - causes

The disease is caused by the attack of cells of the immune system on their own proteins, located on the cells of the liver. However, the answer to why this is so is unknown. Scientists speculate that the cause of this process may be a genetic predisposition to the so-called autoimmune reaction. This theory is confirmed by studies which show that patients with AZW often have coexistence of other autoimmune diseases (thyroiditis, ulcerative colitis, rheumatoid arthritis, diabetes, vitiligo, celiac disease, etc.).

Autoimmune hepatitis - symptoms

The course of the disease may be scanty or asymptomatic, or vice versa - very severe. Unfortunately, the most common diagnosis is the oligosymptomatic form of autoimmune hepatitis. Then the dominant symptom, and sometimes the only one, is weariness, which increases during the day and makes functioning difficult. It is a non-specific symptom, which may be a symptom of ordinary fatigue, which is why it is often underestimated by the patient. Sometimes the fatigue may be accompanied by symptoms such as:

  • aches and pains in the right hypochondrium
  • flatulence
  • eating disorders
  • itchy skin

Women should worry about irregular periods, increased body hair or intensification of acne. These are symptoms that indicate a hormonal imbalance that canaccompany the disease.

In the course of symptomatic autoimmune hepatitis, jaundice and symptoms resembling acute viral hepatitis appear, i.e .:

  • nausea and vomiting
  • anorexia
  • crushing epigastric pain
  • fatigue
  • pain in joints, muscles
  • low fever

Autoimmune hepatitis - diagnosis

First, you should interview the patient and ask about all symptoms, past infections or recent treatments. The doctor then performs a physical examination to assess liver size, skin color, splenomegaly (enlargement of the spleen), cutaneous spider veins or ascites, and peripheral edema. Liver ultrasound is also performed along with the measurement of portal flow (Doppler). Endoscopic evaluation of esophageal varices may also be necessary.

An important diagnostic element are blood tests - the so-called liver tests. In patients with AZW, they show an increased activity of ALAT (alanine aminotransferase) and the presence of high levels of gamma globulins, IgG, and the presence of antitubular antibodies in the serum of patients (the presence of autoantibodies in the blood serum is one of the elements necessary for the diagnosis of AS). This makes it easier to perform a differential diagnosis, which should take into account diseases with the presence of inflammatory changes in the liver (including hepatitis C or hepatitis B, Wilson's disease and PSC - primary sclerosing cholangitis).

In order to make the final diagnosis, a pathomorphological examination of the liver (liver biopsy) is performed, thanks to which it is possible to detect billet necrosis and periportal inflammatory changes, as well as a different degree of organ fibrosis, which is characteristic of the disease.

Autoimmune Hepatitis - Treatment

In the case of AD, immunosuppressive treatment is used, which consists in inhibiting the production of antibodies and immune cells by various factors called immunosuppressants (most often these are drugs). In the case of AZW, the immunosuppressants are corticosteroids (e.g. prednisolone) and azathioprine (combination therapy).

AZW is a chronic disease, but there are generally periods of remission. It is possible to discontinue the drugs during their duration, provided that the biochemical test results have been normal for two years and the remission of the disease is confirmed by liver biopsy. Its relapse does not always translate into a deterioration in well-being, so patients must be under the supervision of doctors from a hepatology clinic.for a lifetime. Unfortunately, there are cases of AD that are very rapid or resistant to treatment. Then a liver transplant is a rescue.

Patients in whom treatment has failed ciclosporin is used, and in cases of liver cirrhosis, the need for liver transplantation should be considered.

AZW allows you to have a normal normal life

In most cases, the disease is not an obstacle to the implementation of personal and professional plans. It also does not require a special diet. It is enough to eat he althy. However, care must be taken not to aggravate the liver damage. Therefore, you should get vaccinated against hepatitis A and B, and completely give up drinking alcohol. You should also keep your body weight within a normal range to prevent nonalcoholic fatty liver disease, and remember that your liver is also harmed by medications. Of course, they should be taken when necessary, e.g. for high blood pressure, coronary heart disease. However, each physician should inform the patient that he suffers from AZW, so that the specialist can prescribe a specific drug that is better tolerated by the affected liver. However, taking over-the-counter medications (e.g. painkillers) should be consulted with a doctor, because even basically safe paracetamol can harm the liver.

Important

Pregnant with AZW

Women with autoimmune hepatitis (ASD) can become pregnant and give birth to a he althy baby even while on medication. However, before they decide to become a mother, their he alth condition should be carefully assessed so that the gynecologist knows how to conduct pregnancy and childbirth. Pharmacological treatment is modified in a different state. Azathioprine is discontinued and steroids are abandoned. There was no negative impact on the fetus. During pregnancy, the immune tolerance increases and the disease calms down, but an exacerbation of the disease should be expected after the birth of a child. Therefore, it is sometimes considered to increase the dose of steroids immediately after giving birth.

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