Diagnosis
Liver biopsy
Liver biopsy
A liver biopsy is a procedure to remove a small sample of liver tissue for laboratory testing. A liver biopsy is commonly performed by inserting a thin needle through the skin and into the liver.
Tests and procedures used to diagnose autoimmune hepatitis include:
- Blood tests. Testing a sample of blood for antibodies can distinguish autoimmune hepatitis from viral hepatitis and other conditions with similar symptoms. Antibody tests also help pinpoint the type of autoimmune hepatitis you have.
- Liver biopsy. A sample of liver tissue may be taken to confirm the diagnosis and to determine the degree and type of liver damage. During the biopsy procedure, a thin needle is passed into the liver through a small cut in the skin. The needle is used to take a small sample of liver tissue. The sample is then sent to a laboratory for testing.
Treatment
The goal of treatment for autoimmune hepatitis is to slow or stop the immune system attack on the liver. This may help increase the time before the disease gets worse. To meet this goal, you'll likely need medicines that lower immune system activity. The first treatment is usually prednisone. A second medicine, azathioprine (Azasan, Imuran), may be recommended in addition to prednisone.
Prednisone, especially when taken long term, can cause a wide range of serious side effects, including diabetes, weakened or broken bones, high blood pressure, cataracts, glaucoma, and weight gain.
Healthcare professionals typically prescribe prednisone at a high dose for about the first month of treatment. Then, to reduce the risk of side effects, they gradually reduce the dose over the next several months until reaching the lowest possible dose that controls the disease. Adding azathioprine also helps you avoid prednisone side effects.
Although you may experience remission a few years after starting treatment, the disease often returns if the drug is discontinued. Depending on your situation, you may need lifelong treatment.
Liver transplant
When medicines don't stop the disease from getting worse or you get scarring that can't be reversed — called cirrhosis — or liver failure, the remaining option is a liver transplant.
During a liver transplant, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplants most often use livers from deceased organ donors. In some cases, a living-donor liver transplant can be used. During a living-donor liver transplant, you receive only a part of a healthy liver from a living donor. Both livers begin regenerating new cells almost right away.
Preparing for your appointment
If you have any symptoms that worry you, start by making an appointment with someone on your primary healthcare team. If your care team suspects that you may have autoimmune hepatitis, you may be referred to a specialist in liver diseases. This type of specialist is called a hepatologist.
Because appointments can be brief and there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready and know what to expect.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along to help you remember everything that was discussed.
- Write down questions to ask your care team.
For autoimmune hepatitis, some basic questions to ask include:
- What's the most likely cause of my symptoms?
- Are there any other possible causes?
- What tests do I need to confirm that I have autoimmune hepatitis?
- How severe is the damage to my liver?
- Is my condition likely temporary or chronic?
- What are my treatment options?
- Can treatment cure my autoimmune hepatitis?
- What are the potential side effects of each treatment option?
- How might treatment for autoimmune hepatitis affect the management of my other medical conditions?
- Could any of my medicines or habits cause my liver problems or make my liver problems worse?
- Are there any dietary restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- How often will I need follow-up visits?
What to expect from your doctor
You'll likely be asked a few questions during the appointment. Being ready to answer them may reserve time to go over any points you want to spend more time on. You may be asked:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Does anything seem to improve or worsen your symptoms?
- Are you taking any medicines or treatments for your symptoms?
- Do you have a family history of liver disease?