Diagnosing Autoimmune Hepatitis in Children

The liver is a large organ in the abdomen that performs many important tasks: It removes toxins from the blood, makes substances that aid in digestion and blood clotting, and stores vitamins and minerals needed throughout the body.

Hepatitis refers to any inflammation of the liver. Autoimmune hepatitis occurs when the immune system, which normally protects the body from infection, attacks healthy cells in the liver, causing chronic inflammation. Without treatment, this inflammation can cause scarring in the liver, known as cirrhosis, and ultimately, liver failure.

Doctors at Hassenfeld Children’s Hospital at NYU Langone have extensive experience in diagnosing and treating autoimmune hepatitis in children.

Risk Factors

The exact cause and factors that may trigger autoimmune hepatitis are unknown. Autoimmune hepatitis tends to occur in girls and young women, especially those who have other autoimmune conditions, such as celiac disease, Crohn’s disease, lupus, rheumatoid arthritis, or Sjogren’s syndrome.

Autoimmune hepatitis is divided into two main types: type 1 is more common in adolescents, and type 2 usually begins during infancy or childhood. Both types have the same symptoms, and children and teens with either type often receive the same treatments.

Symptoms

Most symptoms of autoimmune hepatitis are minor and vague—for example, nausea, fatigue, abdominal pain, and a loss of appetite. Some, but not all, children with this condition develop jaundice, a yellowing of the eyes and skin. Jaundice occurs when the liver isn’t effective in removing bilirubin, a waste product formed when the liver breaks down hemoglobin, which gives blood its red color. When blood contains too much bilirubin, it can make urine appear darker and skin feel itchy.

Your child’s stools may appear oily, because chronic inflammation in the liver can disrupt the production of bile salts, which help to digest fats.

Over time, autoimmune hepatitis may lead to a buildup of fluid in the abdomen, called ascites. Mental confusion may also result, as the liver becomes less effective at removing toxins from the blood. If not controlled, autoimmune hepatitis can lead to liver failure.

Our experts use results of a physical exam, blood tests, imaging tests, and a liver biopsy to make a diagnosis.

Physical Exam

A doctor may suspect autoimmune hepatitis if your child has unexplained flu-like symptoms and one or more unusual symptoms, such as jaundice or dark-colored urine. During a physical exam, the doctor looks for signs of hepatitis. First, the doctor examines your child’s skin and eyes for signs of jaundice. The doctor also feels the abdomen to determine whether the liver and the spleen—an organ on the opposite side of the abdomen that filters the blood—are swollen.

Enlargement of the spleen could mean that your child’s symptoms are caused by an infection. It could also mean that your child has already developed cirrhosis of the liver.

Blood Tests

Blood test results can help determine whether your child has inflammation in the liver and can confirm the presence of autoantibodies. These proteins, which mistakenly attack healthy tissues in the body and cause inflammation, are a sign that an autoimmune reaction is occurring. A small sample of your child’s blood is drawn in the doctor’s office and is sent to an NYU Langone laboratory for evaluation.

Blood tests measure the following:

• liver enzymes, which become elevated anytime the liver is inflamed
• antinuclear antibodies and immunoglobulin G antibodies, which are associated with some autoimmune disorders, including autoimmune hepatitis
• anti–smooth muscle antibodies, which attack a type of tissue in the liver and are usually present in people with type 1 autoimmune hepatitis
• antibodies to liver and kidney microsomes, which also attack tissues in the liver and are associated with type 2 autoimmune hepatitis

Abdominal Ultrasound

An abdominal ultrasound may be used to see whether the liver has become enlarged. In this test, a technician or doctor places a handheld device called a transducer on your child’s abdomen. The transducer uses high-frequency sound waves and a computer to obtain a picture of your child’s liver and nearby blood vessels to look for swelling and inflammation.

Liver Biopsy

A liver biopsy is performed to confirm a diagnosis of autoimmune hepatitis and determine the severity, or extent, of the condition. In this test, the doctor numbs a small area of skin on your child’s abdomen with a local anesthetic before inserting a needle to remove a tiny amount of liver tissue. The tissue sample is sent to an NYU Langone pathology laboratory, where it is examined for signs of damage. Biopsy results usually take about two days.

Our experts use the results of your child’s blood tests and liver biopsy to develop a treatment plan to reduce inflammation and prevent further scarring in the liver.