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]
Overview
Diagnostic Study of Choice
Gold standard/Study of choice:
- Liver biopsy is the gold standard test for the diagnosis of autoimmune hepatitis[1][2][3][4]
- 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
- Portal lesion spares the biliary tree
- This involves most of the lobule
- Lobular collapse which is best identified by reticulin staining
- There is lymphoplasmacytic periportal infiltrate which invade the limiting plate
- There is an abundance of plasma cells and eosinophils are usually present
- A plasma cell infiltrate lead to plasma cell hepatitis, If it involves lobules called lobular or whole liver known as panacinar hepatitis
In cirrhosisfollowing findings are seen on biopsy:
Overlap syndrome
Liver biospy is gold standard for diagnosing overlap syndrome[5][6]
| Histology findings of overlap syndrome | |
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| Types | Biopsy findings |
| AIH-PBC |
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| AIH-PSC |
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| AIH-cholestatic syndrome |
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References
- ↑ Carpenter HA, Czaja AJ (2002). "The role of histologic evaluation in the diagnosis and management of autoimmune hepatitis and its variants". Clin Liver Dis. 6 (3): 685–705. PMID 12362575.
- ↑ Szabó Z (2006). "[The role of liver biopsy in the diagnosis of autoimmune hepatitis]". Orv Hetil (in Hungarian). 147 (35): 1697–702. PMID 17051746.
- ↑ Suzuki A, Brunt EM, Kleiner DE, Miquel R, Smyrk TC, Andrade RJ, Lucena MI, Castiella A, Lindor K, Björnsson E (2011). "The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury". Hepatology. 54 (3): 931–9. doi:10.1002/hep.24481. PMC 3192933. PMID 21674554.
- ↑ Tiniakos DG, Brain JG, Bury YA (2015). "Role of Histopathology in Autoimmune Hepatitis". Dig Dis. 33 Suppl 2: 53–64. doi:10.1159/000440747. PMID 26642062.
- ↑ Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ (2010). "Diagnosis and management of primary sclerosing cholangitis". Hepatology. 51 (2): 660–78. doi:10.1002/hep.23294. PMID 20101749.
- ↑ Dienes HP, Erberich H, Dries V, Schirmacher P, Lohse A (2002). "Autoimmune hepatitis and overlap syndromes". Clin Liver Dis. 6 (2): 349–62, vi. PMID 12122860.