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Gastroenterology and Hepatology Autoimmune Hepatitis Diagnosis Autoimmune hepatitis primarily develops in women aged 20 to 40 years. The clinical presentation ranges from asymptomatic elevation of aminotransferase levels to acute liver failure. Other findings include: r elevated IgG levels o positive ANA and anti-smooth muscle antibody titers o positive p-ANCA or anti-LKM I antibody Liver biopsy establishes the diagnosis. Fifty percent of patients with autoimmune hepatitis have other autoimmune diseases, such as thyroiditis, ulcerative colitis, or synovitis. DOil'T BETRTCKED . High serum total protein and low serum albumin levels suggest an elevated serum y-globulin level, which may be the only clue to hypergammaglobulinemia. Treatment Patients who have active inflammation on liver biopsy specimens or are symptomatic should be considered for treatment with glucocorticoids and azathioprine. Relapse occurs after stopping treatment in most patients. Alcoholic Hepatitis Diagnosis Acute alcoholic binges may cause fatty liver. Hepatic steatosis with inflammation is called alcoholic steatohepatitis. Mild forms of alcoholic steatohepatitis are common, usually asymptomatic, and associated with mild elevations in aminotransferase levels. Severe alcoholic steatohepatitis is called alcoholic hepatitis and is symptomatic. The clinical presentation includes: o jaundice, leukocytosis, and tender hepatomegaly, with or without fever r findings consistent with portal hypertension (may be present) . AST and ALT measurements <300 to 500 U/L, with an AST/ALT ratio >2.0 Treatment Abstinence from alcohol is indicated for all patients. Prednisolone is indicated for patients with a Maddrey Discriminant Function (MDF) score >32, Model for End-Stage Liver Disease (MELD) score >20, or encephalopathy. If the bilirubin level (or Lille score) does not improve by day 7 , prednisolone should be discontinued. DO]I'? BE TRICKED . Do not use glucocorticoids in patients with alcoholic hepatitis and GI bleeding, infection, pancreatitis, or kidney disease. 103