Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 471

Autoimmune hepatitis (AIH), as the name implies, is an autoimmune disease of the liver that can present as acute elevations in liver enzymes, fulminant hepatic failure, chronic elevations, or cirrhosis. Often there are serologic markers of positive antinuclear antibodies, smooth muscle antibodies, and hypergammaglobulins. Histologically shows hepatitis with a plasma cell infiltrate. Although AIH is considered a disease of children and adolescents, about 20% of adults with AIH develop the disease after age 60.²⁸ The male‐to‐female ratio is 1:3 in elderly patients with AIH. This disease must always be looked for as it can often be readily treated with prednisone, azathioprine, and/or budesonide. Drug‐induced AIH hepatitis usually resolves within one to three months after the offending medication is discontinued and must always be considered, especially in the elderly. Nitrofurantoin, statins, minocycline, and diclofenac are known to cause drug‐induced AIH‐like hepatitis.²⁹ In patients with cirrhosis, treatment should include prednisone; but in noncirrhotics, budesonide can be used. Portal hypertension will shunt budesonide around the liver.