Difference between revisions of "Medical liver disease"

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Medical liver disease (view source)

Revision as of 11:01, 9 August 2013

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→‎Autoimmune hepatitis: split out
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=Autoimmune=
=Autoimmune=
==Autoimmune hepatitis==
==Autoimmune hepatitis==
*Abbreviated ''AIH''.
{{Main|Autoimmune hepatitis}}
===General===
*Several criteria exist to diagnose and histology (alone) is '''not''' sufficient.
 
====Diagnosis====
Simplifed diagnostic criteria (2008):<ref name=pmid19675998>Scoring systems for the diagnosis of autoimmune hepatitis: past, present, and future. Wiegard C, Schramm C, Lohse AW. Semin Liver Dis. 2009 Aug;29(3):254-61. Epub 2009 Aug 12. PMID 19675998</ref>
#Antibody titer.
#Elevated IgG.
#Liver pathology.
#Exclusion of viral hepatitis.
 
Details (scoring):<ref name=pmid19675998/>
{| class="wikitable sortable"
|-
|'''Finding'''          || '''Score'''
|-
|ANA or SMA 1:40 || 1 point
|-
|ANA or SMA 1:80 || 2 points
|-
|LKM-1 1:40 || 2 points
|-
|IgG upper normal || 1 point
|-
|IgG 1.1x upper limit || 2 points
|-
|Histology compatible || 1 point
|-
|Typical AIH histo. || 2 points
|-
|No viral hepatsis || 2 points
|-
|}
 
Interpretation:
Definite >= 7 points.
Probable = 6 points.
 
Notes:
*Autoantibodies may be seen in HCV.<ref name=pmid19675998/>
*A normal IgG is very unusual in AIH - but may be seen in atypical variants with zone III involvment.
 
Abbreviations:
*ANA = anti-nuclear antibody.
*SMA = smooth muscle antibody.
*LKM-1 = liver kidney microsomal type 1 antibody.
 
===Microscopic===
Classification:<ref name=pmid19675998/>
*Typical:
**Interface hepatitis (zone 1).
***Lymphoplasmacytic infiltration of portal tracts / lobule.
****Periportal [[plasma cells]] - '''key feature'''.<ref>{{Ref PCPBoD8|448}}</ref>
**Emperipolesis - one cell penetrates into another one (uncommon finding).
**Hepatic rosette - inflammatory cells around reactive hepatocytes.<ref name=pmid20527613>{{Cite journal  | last1 = Malik | first1 = TA. | last2 = Saeed | first2 = S. | title = Autoimmune hepatitis: a review. | journal = J Pak Med Assoc | volume = 60 | issue = 5 | pages = 381-7 | month = May | year = 2010 | doi =  | PMID = 20527613 | url=http://www.jpma.org.pk/full_article_text.php?article_id=2051 }}</ref>
*Compatible:
**Chronic hepatitis - lymphocytic dominant.
*Atypical:
**Signs of an other disease.
 
Notes:
*[[PAS stain]] may be useful - find plasma cells.<ref>URL: [http://iv.iiarjournals.org/content/19/6/1097.abstract http://iv.iiarjournals.org/content/19/6/1097.abstract]. Accessed on: 9 December 2010.</ref>
**Lots of plasma cells should prompt consideration of AIH.
*Atypical Autoimmune hepatitis may have zone III involvment (lymphoplasmacytic infiltrate)<ref name=pmid19452572>Non-classical phenotypes of autoimmune hepatitis and advances in diagnosis and treatment. Czaja AJ, Bayraktar Y. World J Gastroenterol. 2009 May 21;15(19):2314-28. Review. PMID 19452572.</ref> and a normal IgG.<ref>FW. 21 September 2009.</ref>
 
====Images====
<gallery>
Image:Autoimmune_hepatitis_-_low_mag.jpg | AIH - low mag. (WC)
Image:Autoimmune_hepatitis_-_intermed_mag.jpg | AIH - intermed. mag. (WC)
Image:Autoimmune_hepatitis_-_cropped_-_very_high_mag.jpg | AIH - cropped - very high mag (WC)
</gallery>
www:
*[http://www.jpma.org.pk/images/may2010/AutoimmuneHepatitisfigure1.jpg AIH (jpma.org.pk)].<ref name=pmid20527613/>
 
Emperipolesis:
*[http://www.ajronline.org/cgi/content/full/185/4/971/FIG3 Emperipolesis (ajronline.org)].
*[http://moon.ouhsc.edu/kfung/jty1/Com07/Com07Image/Com705-05b.gif Emperipolesis (ouhsc.edu)].
 
===Treatment===
*Immunosuppresants (prednisone, azathioprine).<ref name=pmid19452572>Non-classical phenotypes of autoimmune hepatitis and advances in diagnosis and treatment. Czaja AJ, Bayraktar Y. World J Gastroenterol. 2009 May 21;15(19):2314-28. Review. PMID 19452572.</ref>


==Primary biliary cirrhosis==
==Primary biliary cirrhosis==
Michael
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