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Complications
By Mayo Clinic staffAutoimmune hepatitis may be associated with a variety of complications or other conditions, including:
- Pernicious anemia. Associated with a number of autoimmune disorders, pernicious anemia occurs when a lack of vitamin B-12 interferes with your body's ability to form red blood cells. Signs and symptoms of pernicious anemia can range from shortness of breath and a rapid heart rate to diarrhea, numbness or tingling in your hands and feet, and personality changes.
- Hemolytic anemia. In this type of anemia, your immune system attacks and breaks down red blood cells faster than your bone marrow can replace them.
- Thrombocytopenic purpura. Platelets are blood cells that play a crucial role in blood clotting. In thrombocytopenic purpura, your immune system attacks and destroys these cells, leading to easy bruising and bleeding.
- Ulcerative colitis. This inflammatory bowel disease can cause severe bouts of watery or bloody diarrhea and abdominal pain. It occurs in as many as two in 10 people with type 1 autoimmune hepatitis.
- Celiac disease. This disease causes an abnormal reaction to gluten, a protein found in most grains. Eating gluten sets off an immune response that damages the small intestine, affecting its ability to absorb nutrients.
- Autoimmune thyroiditis (Hashimoto's thyroiditis). In this condition, the immune system attacks the thyroid gland. In some people this causes the gland to secrete too little thyroid hormone (hypothyroidism). In others, the gland initially produces too much hormone (hyperthyroidism) and then produces too little.
- Type 1 diabetes. In type 1 diabetes, the immune system targets and destroys the insulin-producing cells in the pancreas. Insulin plays a vital role in making glucose — the body's fuel — available to cells. Without insulin, cells starve, and glucose builds up in the bloodstream. Diabetes is a serious illness that can damage organs throughout the body.
- Rheumatoid arthritis. Another autoimmune disease, rheumatoid arthritis occurs when the immune system attacks the lining of your joints, leading to stiffness, pain, swelling, and sometimes to deformity and disability.
Because symptoms don't always appear in the early stages of the disease, some people with autoimmune hepatitis develop irreversible scarring of liver tissue (cirrhosis) before they're ever diagnosed. Complications of cirrhosis include:
- Increased blood pressure in the vein that sends blood into the liver. Blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. If scar tissue blocks normal circulation through your liver, this blood backs up, leading to increased pressure within the portal vein (portal hypertension).
- Enlarged veins (varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels — mainly those in your stomach and esophagus. Sometimes veins also form around your navel and at the rectum. The blood vessels are thin walled, and because they're filled with more blood than they're meant to carry, they're likely to bleed. Massive bleeding in the upper stomach or esophagus from these blood vessels is a life-threatening emergency that requires immediate medical care.
- Fluid retention. Liver disease can cause large amounts of fluid to accumulate in your legs (edema) and abdomen (ascites). Several factors play a role, including portal hypertension and changes in the hormones and chemicals that regulate fluids in your body. Ascites can be uncomfortable and may interfere with breathing and is usually a sign of advanced cirrhosis.
- Bruising and bleeding. Scarring of the liver (cirrhosis) interferes with the production of proteins that help your blood clot and with the absorption of vitamin K, which plays a role in synthesizing these proteins. As a result you may bruise and bleed more easily than normal. Bleeding in the gastrointestinal tract is particularly common.
- Mental changes. A damaged liver has trouble removing toxins from your body — normally one of the liver's key tasks. The buildup of toxins such as ammonia — a byproduct of protein digestion — can damage your brain, leading to changes in your mental state, behavior and personality (hepatic encephalopathy). Symptoms of hepatic encephalopathy include forgetfulness, confusion and mood changes.
- Liver failure. This occurs when extensive damage to liver cells makes it impossible for your liver to function. At this point, a liver transplant is the only option.
- Liver cancer. Cirrhosis is one of the most common causes of hepatocellular carcinoma, the main form of liver cancer.
