Ischemic Hepatitis

GENERAL PRINCIPLES

Ischemic hepatitis results from acute liver hypoperfusion. Clinical circumstances associated with acute hypotension or hemodynamic instability include severe blood loss, substantial burns, cardiac failure, heat stroke, sepsis, sickle cell crisis, and others.

DIAGNOSIS

Clinical Presentation

Ischemic hepatitis presents with an acute, frequently transient, and severe rise of aminotransferases during or following an episode of liver hypoperfusion.

Diagnostic Testing

• Laboratory studies show a rapid rise in levels of serum AST, ALT (gt;1000 mg/dL), and lactate dehydrogenase (LDH) within 1-3 days of the insult.

• Total bilirubin, ALP, and INR may initially be normal but subsequently rise as a result of reperfusion injury.

DIAGNOSTIC PROCEDURES

Liver biopsy is not routinely needed because the diagnosis can usually be made with clinical history. Classic histologic features include variable degrees of zone 3 (centrilobular) necrosis with collapse around the central vein. Coexistent features may include passive congestion, sinusoidal distortion, fatty change, and cholestasis. Inflammatory infiltrates are rare.

TREATMENT

Treatment consists of supportive care and correction of the underlying condition that caused the circulatory collapse.

Outcome and Prognosis

Prognosis is dependent on rapid and effective treatment of the underlying condition.