الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
 |  | from | 159 |  |  |
| | | from | 159 | | |
Abstract
Hepatitis is a general term which refers to inflammation of the liver. This inflammation can result from various infectious and non-infectious etiologies. Infectious etiologies include viral, bacterial, fungal and parasitic organisms. Non-infectious hepatitis may be caused by medications, toxins and autoimmune disorders.
Autoimmune hepatitis (AIH) is a progressive inflammatory disease of the liver; it causes a progressive destruction of hepatic parenchyma, and develops into cirrhosis and liver failure if immunosuppressive treatment is not initiated early.
Autoimmune hepatitis should be suspected and excluded in all children presented with symptoms and signs of prolonged or sever liver disease.
The present study was designed to examine significance of ANA and ASMA titres in children presented by acute hepatitis with prolonged elevation of liver transaminases. This study was conducted on 40 cases of acute hepatitis with persistent elevation of liver transaminases one month after presentation.
All patients were subjected to: full history taking, thorough clinical examination and laboratory investigations (total and direct bilirubin, serum transaminases and autoantibodies ”ANA, ASMA and AMA”). Samples were taken at 1st presentation and one month later.
The results of this study revealed that:
• There were 21 males and 19 females included in the study with a mean age of 8.59 ± 1.95 years.
• Dark urine was the most common presenting symptoms followed by fever and abdominal pain.
• Jaundice was the most common sign followed by hepatomegaly.
• Serum transaminases were still elevated one month after presentation.
• 4 cases out of the 40 cases showed positive autoantibodies
o Two of them had hepatomegaly.
o They were 3 females and one male
o Two cases were ANA positive with a titre of 1/80; on follow up and further investigations they were diagnosed to have a prolonged HAV infection.
o One case was AMA positive with a titre of 1/80, but it showed normal serum alkaline phosphatase; the case was instructed for annual reassessment for possible development of PBC.
o The last case was ANA positive with a titre of 1/160 and ASMA positive with a titre of 1/80; further investigations were done including hepatitis markers and percutenceous liver biopsy. Patient was diagnosed to have autoimmune hepatitis and a course of treatment was started.
In the end of this work, we recommended the following:
1) Autoimmune hepatitis should be in mind when dealing with a case presenting by acute hepatitis.
2) Cases presenting by acute hepatitis must be followed up till serum transaminases return to normal values.
3) Auto antibodies (ANA and ASMA) can be used as a marker in diagnosis of autoimmune hepatitis.
4) Usage of auto antibodies (ANA and ASMA) must be in association with other factors as elevated serum transaminases and presence of other histological evidences.
5) Wide scale studies must be designed to examine the prevalence of elevated serum transaminases associated with positive autoantibodies in pediatric age.