Rarely, rash or unexplained fever may appear. In women, the absence of menstruation (amenorrhoea) is a frequent feature. Physical examination may be normal, but it may also reveal signs and symptoms of chronic liver disease. Many people have only laboratory abnormalities as their initial presentation, as unexplained increase in transaminases and are diagnosed during an evaluation for other reasons. Others have already developed cirrhosis at diagnosis. Of note, alkaline phosphatase and bilirubin are usually normal. Autoimmune hepatitis may overlap with other autoimmune conditions, mainly type 1 diabetes mellitus, ulcerative colitis, lupus, celiac disease, vasculitis, and autoimmune thyroiditis. Cause
The prevailing theory for the development of autoimmune hepatitis is thought to be the interplay of genetic predisposition, an environmental trigger (virus, drugs, herbs, immunizations), and failure of the native immune system resulting in chronic inflammation of hepatocytes and subsequent fibrosis of the liver.There is no specific evidence of the cause. Sixty percent of patients have findings associated with chronic hepatitis but without serologic evidence of a viral infection. The disease is strongly associated with anti-smooth muscle autoantibodies.The exact genes and triggers responsible remain undefined, but studies show association of early-onset, severe disease with the HLA-DR3 serotype and late-onset disease with the HLA-DR4 serotype. Diagnosis
The diagnosis of autoimmune hepatitis is best achieved with a combination of clinical, laboratory, and histological findings after excluding other etiological factors (e.g. viral, hereditary, metabolic, cholestatic, and drug-induced liver diseases). The requirement for histological examination necessitates a liver biopsy, typically performed with a needle by the percutaneous route, to provide liver tissue.
Posthitis (pronounced pos-THI-tis) is the inflammation of the foreskin (prepuce) of the penis. It is characterised by swelling and redness on the skin and it may be accompanied by a smelly discharge. The term posthitis comes from the Greek "posthe", meaning foreskin, and "-itis", meaning inflammation. Causes
Posthitis can have infectious causes such as bacteria or fungi, or non-infectious causes such as contact dermatitis or psoriasis. The inflammation may be caused by irritants in the environment. Common causative organisms include candida, chlamydia, and gonorrhea. The cause must be properly diagnosed before a treatment can be prescribed. A common risk factor is diabetes. Posthitis can lead to phimosis, the tightening of the foreskin which makes it difficult to retract over the glans. Posthitis can also lead to superficial ulcerations and diseases of the inguinal lymph nodes. Prevention
Hygiene, in particular the regular cleaning of the glans, is generally considered sufficient to prevent infection and inflammation of the foreskin. Full retraction of the foreskin may not be possible in boys younger than about ten years and some may not be able to fully retract their foreskin for cleaning until their late teens. Treatment
If contact dermatitis is suspected, soaps and other external irritants should be discontinued and a latex allergy should be investigated. The treatment depends on identification of the cause. Irritants in the environment should be removed.