How Autoimmune Hepatitis Is Diagnosed

Autoimmune hepatitis is an autoimmune disease that occurs when the body’s immune system attacks the liver by mistake. The exact cause is unknown but believed to be due to a combination of genetic and environmental factors.

There is no one test to diagnose autoimmune hepatitis. The diagnostic process usually involves a physical exam, detailed history, lab tests, imaging studies, and a liver biopsy. 

a woman consulting a doctor

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Self-Checks/At-Home Testing

There is no home test to diagnose autoimmune hepatitis, but it is helpful to be aware of the common symptoms of the disease, which can include:

  • Fatigue
  • Abdominal pain or discomfort
  • Achy joints
  • Itching
  • Nausea
  • Loss of appetite 
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Dark urine
  • Pale (clay-colored) stools
  • Spider-like blood vessels 
  • Absence of menstruation
  • Confusion
  • Fluid buildup in the abdomen, known as ascites

Physical Examination

Your appointment with your doctor will most likely start with a detailed history and physical exam. Your liver is located on the right side of your abdomen just under the ribcage. Your doctor will palpate your abdomen to determine if your liver feels enlarged. An enlarged liver is a sign of hepatitis. 

Your doctor will ask several questions about the symptoms you have been experiencing. Be prepared to answer questions about when they started and how severe they feel. 

Your doctor will also ask about your medical history. Certain autoimmune conditions have been associated with an increased risk of autoimmune hepatitis. Your doctor may ask if you or your family members have been diagnosed with:

Because autoimmune hepatitis can be triggered by a drug reaction, your doctor will also ask for a list of the current medications you are taking. Let them know if you have ever taken any of the following medications because they can raise your risk of developing autoimmune hepatitis:

  • Nitrofurantoin
  • Minocycline
  • Halothane
  • Atorvastatin
  • Isoniazid
  • Diclofenac
  • Propylthiouracil
  • Infliximab 

Labs and Tests

Once your doctor has performed a physical exam and asked for a detailed health history, they will likely order blood tests. These tests can tell you if your liver is inflamed or has been damaged.

Blood tests used to diagnose autoimmune hepatitis include:

  • Liver enzymes: Elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) indicate inflammation in the liver.
  • Liver function tests: Levels of bilirubin, cholinesterase, and thrombocytes can indicate if there is liver damage.
  • Serum IgG and other gamma globulins: Elevated levels without the presence of cirrhosis usually indicate autoimmune hepatitis.
  • Anti-liver kidney microsome type 1 antibody (anti LKM-1): Elevated levels can indicate autoimmune hepatitis. 
  • Anti-smooth muscle antibody (SMA): Elevated levels can indicate autoimmune hepatitis. 

Imaging

If any of your blood tests come back abnormal, the next step may be to order imaging tests to visualize your liver. To view your liver, your doctor may recommend a CT scan or ultrasound. 

If your doctor strongly suspects that you have autoimmune hepatitis, the last step in the diagnostic process is to obtain a liver biopsy. The doctor will remove small tissue samples from your liver with a large needle.

These samples are then sent to the lab to be studied under a microscope. This test can help your medical team determine which kind of liver disease you have.

Differential Diagnosis 

During the diagnostic process, your medical team will work to rule out other possible causes for your symptoms and lab findings. Other types of liver disease and chronic conditions may present with similar signs as autoimmune hepatitis, so it is important to rule them out before proceeding with treatment. 

First, your medical team will work to figure out which type of hepatitis you have. Hepatitis refers to inflammation of the liver and can be caused by a variety of factors, including viruses, alcohol abuse, medications, and chronic conditions. Viral causes of hepatitis include:

Other forms of liver disease may also have similar symptoms to autoimmune hepatitis. Your medical team will rule out the following liver diseases during your workup:

How to Prepare for Your First Appointment With a Hepatologist

Think through the questions that the doctor may ask you. Schedule some time to sit down and take notes before the appointment. Write down each of your symptoms and how long they have been going on. Think about any family members who have a history of liver disease or autoimmune conditions, and write them down as well. Finally, create a list of all of the medications, vitamins, and supplements you are currently taking. 

Summary

There is no one test to diagnose autoimmune hepatitis. Your doctor will have to rule out other conditions in a process of elimination to arrive at the accurate diagnosis. They will order liver enzymes and liver function tests to see whether there is inflammation in your liver. They will also order tests that detect certain antibodies that have been associated with autoimmune hepatitis. If your doctor thinks you may have autoimmune hepatitis, they will also order imaging and a liver biopsy to better understand your condition.

A Word From Verywell

If you are currently going through the diagnosis process for autoimmune hepatitis, you’re most likely feeling anxious, confused, and frustrated. This is an incredibly challenging time, and taking things one day at a time is important. 

During this process, expect to undergo a physical exam, blood tests, and possibly a liver biopsy. Your doctor will also need to ask several questions about your health and family history. Once you have been diagnosed with autoimmune hepatitis, the next step will be to sit down with your hepatologist to determine your treatment plan. 

Frequently Asked Questions 

What happens after being diagnosed with AIH?

After you have been diagnosed with autoimmune hepatitis, your doctor will sit down with you to develop a treatment plan. If you are not already seeing a liver specialist, who is known as a hepatologist, you will be referred to one. 

Can an autoimmune hepatitis diagnosis be something else?

Some symptoms and lab findings found in autoimmune hepatitis are also common in other chronic conditions. Your medical team will work to rule out any other possible causes for your symptoms. Some diseases to rule out include other types of hepatitis, certain viral infections, and other liver conditions such as cirrhosis and fatty liver disease.

What tests are used to diagnose autoimmune hepatitis?

Autoimmune hepatitis is usually diagnosed by blood tests and a liver biopsy. The blood tests to expect include liver enzymes, liver function tests, serum IgG and other gamma globulins, anti-liver kidney microsome type 1 antibody, and anti-smooth muscle antibody.

Is an AIH diagnosis fatal?

If left untreated, autoimmune hepatitis could be fatal. Early diagnosis and treatment are essential to achieving a good prognosis.

For individuals who respond positively to treatment, the 10-year survival rate is about 83.8% to 94%. Without any treatment, 40% to 50% of individuals with severe autoimmune hepatitis will die within six months to five years.

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