Autoimmune hepatitis Diagnostic of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: :Manpreet Kaur, MD [2]

Diagnostic Study of Choice

Gold standard/Study of choice:

• Liver biopsy is the gold standard test for the diagnosis of Autoimmune hepatitis
• Liver biopsy is performed by following methods:
  • Percutaneous liver biopsy with or without ultrasound guidance
  • Transjugular liver biopsy

Histology findings usually found on biopsy:

• Interface hepatitis (ie, piecemeal necrosis) is the histological hallmark
  • There is lymphoplasmacytic periportal infiltrate which invade the limiting plate
  • There is an abundance of plasma cells and eosinophils are usually present
  • Portal lesion spares the biliary tree
• A plasma cell infiltrate lead to plasma cell hepatitis, lobular, or panacinar hepatitis
• Bridging necrosis
• Fibrosis
• Fibrosis is present in all but the mildest forms of AIH. It causes distortion of the hepatic lobule and the appearance of regenerative nodules, resulting in cirrhosis

Fibrosis is present in most patients with autoimmune hepatitis. Without effective therapy, fibrosis starts to connect the portal and central areas, which ultimately leads to cirrhosis.