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Diagnosing Autoimmune Hepatitis
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Melissa Palmer, MD posted:
@font-face { font-family: "Times New Roman"; }p.MsoNormal, li.MsoNormal, div.MsoNormal { margin: 0in 0in 0.0001pt; font-size: 12pt; font-family: Times; }table.MsoNormalTable { font-size: 10pt; font-family: "Times New Roman"; }div.Section1 { page: Section1; }There is no single test that will accurately diagnose AIH. However, many factors taken together can provide the basis for an accurate diagnosis. Most importantly, in order to have an accurate diagnosis of AIH, it is necessary to first eliminate all other causes of chronic liver disease, such as viral hepatitis, primary biliary cirrhosis, hemochromatosis, excessive alcohol consumption, and drug-induced liver disease including liver disease caused by herbal preparations.
In contrast to other liver diseases, such as chronic hepatitis C or hemochromatosis, AIH is a liver disease in which the degree of transaminase elevation and the se?verity of symptoms often (although not always) correlate with the degree of liver damage and inflammation. Many times, the dramatic improvement of symptoms and normalization of transaminase levels with treatment will essentially prove or confirm the diagnosis of AIH. However, liver function tests (LFTs), autoimmune blood tests, genetic markers, and liver biopsy findings, when evaluated together, in addition to response to therapy, more typically are used to confirm the diagnosis.


Liver Function Tests (LFTs)

Typically, transaminase levels (AST and ALT) are predominantly elevated and GGTP and alkaline phosphatase (AP) are normal or close to normal. If the AP is very elevated in conjunction with normal or only slightly elevated transaminase levels, a diagnosis other than AIH should be considered.
In severe cases of AIH, transaminase levels are very elevated. Transaminase elevations may be as much as ten to twenty times normal values. For example, AST and ALT may be around 400 to 800 IU/L, and the bilirubin level may be around 10 mg/dl. In milder cases, the transaminase levels are only slightly elevated, around 60 to 200 IU/L, and the bilirubin level is normal. In any scenario, when liver function tests are elevated, other more specific blood tests for AIH should be run.

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