Ischemic Hepatitis: Clinical Features, Diagnosis and Prognosis

Abstract

Nineteen episodes of ischemic hepatitis were diagnosed by hepatitic liver function tests and characteristic liver pathology in 17 patients. All patients had an acute illness associated with a likely fall in cardiac output although only five episodes were associated with documented hypotension. Right ventricular failure was severe in only four, mild in six, and absent in nine whilst left ventricular failure was clinically apparent in 16. The hepatitic illness was usually mild. No patient died as a direct result of hepatic damage, prognosis depending on the underlying cardiac or systemic disease. Liver function tests were characterised by a marked rise in serum transaminase levels with a parallel increase in serum lactic dehydrogenase of hepatic origin and a short time course of the enzyme elevation lasting 3 to 11 days. It is concluded that ischemic hepatitis is caused by poor hepatic perfusion associated with an acute fall in cardiac output; is usually a subclinical illness with little influence on prognosis, and may be accurately differentiated from viral hepatitis on clinical and biochemical criteria alone.

Outcomes and predictors of in-hospital mortality among cirrhotic patients with non-variceal upper gastrointestinal bleeding in upper Egypt

“…Defined as an 8-fold increase or greater in aspartate transaminase and alanine transaminase levels over normal or baseline values (18).…”

Hypoxic hepatitis caused by acute exacerbation of chronic respiratory failure: A case-controlled, hemodynamic study of 17 consecutive cases

“…In HH originating from CHF, the onset is usually precipitated by one or more acute cardiac events, the most frequent being arrhythmia or pulmonary edema. [1][2][3][4] In the present study, such an event was observed in every episode of HH caused by CHF (control group 1). On the contrary, when HH was caused by an acute exacerbation of CRF, no precipitating factor could be elicited except for progressive deterioration of the respiratory status.…”

“…The review of published series including at least 4 cases of HH 1,2,4,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] shows that exacerbation of CRF in patients free of left cardiac failure was the cause of HH in only 7 of 263 cases (2.6%). Moreover, clinical studies of asthmatic or CRF patients have reported normal or only slightly affected liver function tests.…”

“…Liver biopsy was not required according to the current opinion that liver histology is not a prerequisite for the diagnosis of HH when the three above criteria are met. [1][2][3][4] Appropriate clinical, biochemical, and hemodynamic data on these 142 episodes of HH were prospectively recorded in special files.…”

“…Arterial hypoxemia was significantly more severe in the study group (arterial blood tension in O 2 Hypoxic hepatitis (HH), more often known as ischemic hepatitis, is a rare, but probably underrated, liver injury with typical clinical, biochemical, and histological features. [1][2][3][4] Cardiac or circulatory failure represents the usual clinical setting, and the most frequent underlying condition associated with HH is congestive heart failure. The laboratory data are characterized by a sharp increase in serum transaminase activities preceded by an early peak of serum lactic dehydrogenase (LDH) activity.…”