Ischemic hepatitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Liver vascular anatomy.png|thumb|Liver vascular anatomy.]] | [[File:Liver vascular anatomy.png|thumb|Liver vascular anatomy.]] | ||
[[File:Biliary system multilingual.png|thumb|Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.]] | [[File:Biliary system multilingual.png|thumb|Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.]] | ||
*Also known as shock liver | *Also known as shock liver | ||
*Condition where the liver is injured acutely due to lack of blood flow for any number of reasons. | *Condition where the liver is injured acutely due to lack of blood flow for any number of reasons. | ||
**Occurs frequently secondary to [[shock]] | **Occurs frequently secondary to [[Special:MyLanguage/shock|shock]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Critically ill patient, may not be able to report symptoms | *Critically ill patient, may not be able to report symptoms | ||
*Findings can include: | *Findings can include: | ||
**[[Weakness]], malaise | **[[Special:MyLanguage/Weakness|Weakness]], malaise | ||
**[[RUQ pain|Abdominal discomfort]] | **[[Special:MyLanguage/RUQ pain|Abdominal discomfort]] | ||
**[[Jaundice]] | **[[Special:MyLanguage/Jaundice|Jaundice]] | ||
**[[hepatic encephalopathy|Encephalopathy]] | **[[Special:MyLanguage/hepatic encephalopathy|Encephalopathy]] | ||
**[[Liver disease induced coagulopathy|Coagulopathy]] | **[[Special:MyLanguage/Liver disease induced coagulopathy|Coagulopathy]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Acute hepatitis causes}} | {{Acute hepatitis causes}} | ||
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==Evaluation== | ==Evaluation== | ||
*[[LFTs]] | |||
*[[Special:MyLanguage/LFTs|LFTs]] | |||
**AST, ALT > 1000s | **AST, ALT > 1000s | ||
**Elevated bilirubin | **Elevated bilirubin | ||
**Elevated alk phosphatase | **Elevated alk phosphatase | ||
*INR | *INR | ||
**[[liver disease induced coagulopathy|Coagulopathy]] | **[[Special:MyLanguage/liver disease induced coagulopathy|Coagulopathy]] | ||
*Consider acetaminophen level | *Consider acetaminophen level | ||
*Acute [[viral hepatitis|hepatitis panel]] | *Acute [[Special:MyLanguage/viral hepatitis|hepatitis panel]] | ||
==Management== | ==Management== | ||
*Treat underlying [[shock]] | |||
*Treat underlying [[Special:MyLanguage/shock|shock]] | |||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] [[Category:Critical Care]] | [[Category:GI]] [[Category:Critical Care]] | ||
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Latest revision as of 23:15, 4 January 2026
Background
Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.
- Also known as shock liver
- Condition where the liver is injured acutely due to lack of blood flow for any number of reasons.
- Occurs frequently secondary to shock
Clinical Features
- Critically ill patient, may not be able to report symptoms
- Findings can include:
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Evaluation
- LFTs
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phosphatase
- INR
- Consider acetaminophen level
- Acute hepatitis panel
Management
- Treat underlying shock
Disposition
- Admit
See Also
External Links
References
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.