Ischemic hepatitis

Background

• 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:
  • Weakness, malaise
  • Abdominal discomfort
  • Jaundice
  • Encephalopathy
  • Coagulopathy

Differential Diagnosis

Acute hepatitis

• Viral hepatitis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
• Acute alcoholic hepatitis
• Acetaminophen toxicity
• Mushroom toxicity
  • Crotinarius mushrooms
  • Gyromitra mushrooms
  • Amanita mushrooms
• Ischemic hepatitis

Evaluation

• LFTs
  • AST, ALT > 1000s
  • Elevated bilirubin
  • Elevated alk phosphatase
• INR
  • Coagulopathy
• Consider acetaminophen level
• Acute hepatitis panel

Management

• Treat underlying shock

Disposition

• Admit

Authors:

Anthony Lucero, Claire, Michael Holtz, Ross Donaldson