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n CME : Your SA Journal of CPD - Autoimmune hepatitis : main article

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Abstract

The diagnosis of AIH is one of exclusion of other causes of chronic hepatitis. Exclude chronic viral hepatitis and where clinically appropriate, herpes simplex virus, EBV and CMV. In children and young adults remember to exclude Wilson's disease. <br>AIH is a frequent cause of chronic hepatitis in black Africans and the elderly and may present as an acute fulminant hepatitis. <br>Minimum autoantibody testing is for SMA, ANA and anti-LKM-1. The SLA is not readily available locally and the use of ANCA and AMA may be appropriate in cases suggestive of overlap syndrome. In 15% of patients, standard autoantibodies will be negative. <br>Treatment is lifelong, the decision to withdraw therapy involves high risk and should be a well-considered one. <br>Overlap syndromes should be considered in patients in whom there is biochemical evidence of bile duct injury. <br>Other autoimmune diseases, growth failure and low bone mass are common associations. <br>Liver histopathology should be supportive of AIH with a cell infiltrate of lymphocytes and plasma cells, interface hepatitis, rosetting of hepatocytes and absence of features

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/content/m_cme/23/8/EJC63011
2005-08-01
2016-12-09
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