General Practice 2022

Autoimmune hepatitis: what é, symptoms and treatment

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Autoimmune hepatitis: what é, symptoms and treatment
Autoimmune hepatitis: what é, symptoms and treatment
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Autoimmune hepatitis is a disease that causes chronic inflammation in the liver that happens due to changes in the immune system, which in the immune system starts to recognize its own cells as foreign and attacks them, causing a decrease in liver function and leading to symptoms such as abdominal pain, yellow skin and severe nausea.

Usually, autoimmune hepatitis appears before the age of 30 and is more frequent in women and, although there is no cure, it can be controlled with treatment, which is done with drugs to control immunity, such as Prednisone and Azathioprine, in addition to a balanced diet rich in fruits, vegetables and cereals, avoiding the consumption of alcohol, fats, excess preservatives and pesticides, according to the orientation of the hepatologist and nutritionist.

Symptoms of autoimmune hepatitis

The symptoms of autoimmune hepatitis are usually non-specific and the clinical picture can range from an asymptomatic patient to the occurrence of liver failure. Thus, the main signs and symptoms that may indicate autoimmune hepatitis are:

  • Excessive fatigue;
  • Loss of appetite;
  • Muscle pain;
  • Constant abdominal pain;
  • Nausea and vomiting;
  • Yellow skin and eyes, also called jaundice;
  • Slight body itch;
  • Joint pain;
  • Swollen belly.

Typically, the disease has a gradual onset, progressing slowly over weeks to months until it leads to liver fibrosis and loss of function if the disease is not identified and treated.However, in some cases, the disease can rapidly worsen, being called fulminant hepatitis, which is extremely serious and can result in death. See more about fulminant hepatitis.

In addition, in a small number of cases, the disease may not cause symptoms, being discovered in routine exams, which show an increase in liver enzymes. It is important that the diagnosis is made early so that the treatment can be established by the doctor, which can avoid complications such as cirrhosis, ascites and hepatic encephalopathy.

Autoimmune hepatitis in pregnancy

The symptoms of autoimmune hepatitis in pregnancy are the same as those of the disease outside this period and it is important that the woman is accompanied by the obstetrician to verify that there are no risks for both her and the baby, which is rare when the disease is still in its initial phase.

In pregnant women who have a more developed disease and have cirrhosis as a complication, follow-up becomes more important, since there is a greater risk of premature birth, low birth weight and the need for cesarean section.Thus, it is important that the obstetrician indicates the best treatment, which is usually done with a corticosteroid, such as Prednisone.

How the diagnosis is made

The diagnosis of autoimmune hepatitis is made by evaluating the signs and symptoms presented by the person and the result of laboratory tests that must be requested by the doctor. One of the tests that confirms the diagnosis of autoimmune hepatitis is the liver biopsy, in which a fragment of this organ is collected and sent to the laboratory to observe changes in the tissue that are indicative of autoimmune hepatitis.

In addition, the doctor may request the measurement of liver enzymes, such as TGO, TGP and alkaline phosphatase, in addition to the measurement of immunoglobulins, antibodies and serology for hepatitis A, B and C viruses.

The person's lifestyle habits, such as excessive alcohol consumption and use of drugs that are toxic to the liver, are also taken into account at the time of diagnosis, thus making it possible to exclude other causes of liver problems.

Types of autoimmune hepatitis

According to the results of antibody tests, autoimmune hepatitis can be classified into some main groups, such as:

  • Autoimmune hepatitis type 1: more common between 16 and 30 years of age, characterized by the presence of ANA and AML antibodies in the blood test, and may be associated with the onset from other autoimmune diseases such as thyroiditis, celiac disease, synovitis and ulcerative colitis;
  • Autoimmune hepatitis type 2: usually appears in children aged between 2 and 14 years, the characteristic antibody is Anti-LKM1, and may appear together with diabetes type 1, vitiligo and autoimmune thyroiditis;
  • Autoimmune hepatitis type 3: similar to autoimmune hepatitis type 1, with positive anti-SLA/LP antibody, but possibly more severe than type 1.

Identification of the type of hepatitis is important so that the best treatment can be indicated in order to relieve symptoms, reduce liver inflammation and prevent disease progression.

How the treatment is done

Treatment for autoimmune hepatitis is indicated by the hepatologist or gastroenterologist, and starts with the use of corticosteroid drugs, such as Prednisone, or immunosuppressants, such as Azathioprine, which reduce acute liver inflammation, keeping it under control over the years, and can be done at home. In some cases, especially in young patients, the use of a combination of Prednisone with Azathioprine may be recommended to reduce side effects.

In the most serious cases, in which it is not possible to control the inflammation with the use of medication, surgery for liver transplantation can be performed, which consists of replacing the diseased liver with a he althy one. After the liver transplant, the patient must be hospitalized for 1 to 2 weeks to ensure that there is no rejection of the new organ.In addition, transplanted individuals must also take immunosuppressants throughout their lives to prevent the body from rejecting the new liver. See more about liver transplantation.

However, as autoimmune hepatitis is related to the immune system and not the liver, after transplantation it is possible for the disease to develop again.

How to eat

The diet for autoimmune hepatitis should be light and low in fatty and industrialized foods, as they can favor liver inflammation, make it difficult to function and promote the aggravation of the disease. Thus, some foods that can be consumed in hepatitis are:

  • Lettuce, tomato, broccoli, carrot, zucchini, arugula;
  • Apple, pear, banana, mango, watermelon, melon;
  • Beans, broad beans, lentils, peas, chickpeas;
  • Seed bread, pasta and brown rice;
  • Chicken, turkey or rabbit meat;
  • Sole, swordfish, sole.

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