Hepatic Ischemia
Diffuse ischemia can cause ischemia hepatitis, where as focal ischemia can cause hepatic infarction or ischemic cholangiopathy.
Ischemic hepatitis.
(Acute Hepatic infarction, hypoxic hepatitis, shock liver)
Ischemic hepatitis is diffuse liver injury secondary to generalized hepatic ischemia from any cause.
The most common cause of ischemic hepatitis are reduced cardiac output, systemic hypotension and systemic hypoxia.
Centrizonal necrosis develops without liver inflammation.
A high aminotransferase level is the only suggestion of hepatitis.
Ischemic hepatitis is suspected in patients with systemic hypoperfusion. Serum aminotransferase rises (up to 200-fold) within hours along with LDH. Serum bilirubin increases only 4-fold. If perfusion is restored, amino transferase falls over 1 to 2 weeks.
Treatment is directed at the underlying cause. In most cases,liver function is fully recovered . Fulminant liver failure,however,can occur in patients with preexisting cirrhosis.
Hepatic Infarction
Hepatic infarction is focal hepatocellular necrosis due to focal hepatic ischemia from any cause.
The most common cause of hepatic infraction is hepatic artery occlusion.
Most hepatic infarcts are asymptomatic and undiagnosed. Some patients experience right upper quadrant pain, fever and nausea and vomiting. Jaundice and high transient elevations of aminotransferase may occur.
Abdominal CT scan can detect a hepatic infarct as a focal, often wedge-shaped lesion of low attenuation. Recognition of hepatic infarction prompts evaluation of the patency of the hepatic artery. Treatment of hepatic infarction is directed at its cause.
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