Recognition
- Fatigue is the most common presenting complaint. Often the only early symptom
- Jaundice and right upper quadrant discomfort in moderate-to-severe disease
- Acute hepatitis presentation: fever, malaise, nausea, anorexia (can mimic viral hepatitis)
- Signs of cirrhosis in advanced disease: spider angiomata, ascites (abdominal fluid accumulation), hepatomegaly (enlarged liver), palmar erythema
- Asymptomatic presentation: discovered incidentally on abnormal liver function tests in a significant proportion
- Associated with other autoimmune conditions: type 1 diabetes, thyroid disease (Hashimoto's, Graves'), rheumatoid arthritis, ulcerative colitis, celiac disease
- Two types: Type 1 (ANA/ASMA positive, any age) and Type 2 (anti-LKM1 positive, more common in children)
MT Relevance
- Mild, well-controlled disease: Massage is appropriate with physician clearance. Avoid deep abdominal pressure over the liver
- Active inflammation or abnormal liver function: Treat with the same caution as moderate liver disease — reduce pressure. Avoid deep tissue, percussion, and abdominal massage
- Corticosteroid use (virtually all patients): Reduce pressure due to tissue fragility, skin thinning, and osteoporosis risk. Fracture risk with vigorous techniques
- Immunosuppression (azathioprine, mycophenolate): Apply infection control measures. Avoid treating if the client has active infections. If the therapist has any skin lesions, delay treatment
- Coagulopathy: If INR is elevated or the client bruises easily, use light effleurage only. No deep friction, cupping, or percussion
- Cirrhosis/advanced disease: Apply all cirrhosis and portal hypertension precautions — abdominal massage contraindicated. Prone may be impossible with ascites
Required Actions
- Screen for autoimmune comorbidities (thyroid disease, RA, IBD, type 1 diabetes) at intake — these modify treatment independently
- Ask about recent liver function tests if the client discloses autoimmune hepatitis. Elevated transaminases and prolonged PT/INR signal active disease and coagulopathy risk
- Refer to physician if the client reports new jaundice, unexplained bruising, or abdominal swelling
Key Takeaways
- Autoimmune hepatitis is a chronic inflammatory liver disease caused by immune attack on hepatocytes — distinct from viral hepatitis.
- Virtually all patients are on corticosteroids and/or immunosuppressants, causing tissue fragility, infection risk, and osteoporosis.
- Severity determines MT modifications: compensated disease allows gentle massage. Decompensated cirrhosis contraindicates systemic massage.
- Coagulopathy (elevated INR, easy bruising) and liver enzyme elevation are key indicators that modify pressure and technique choices.
- Screen for autoimmune comorbidities and ask about recent liver function tests at intake.