Ischemic hepatitis

Background

Liver vascular anatomy.

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

Differential Diagnosis

Causes of acute hepatitis

• Acetaminophen toxicity (most common cause of acute liver failure in the US)
• Viral hepatitis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
  • HSV
  • Epstein-Barr virus
  • Varicella zoster virus
• Toxoplasmosis
• Acute alcoholic hepatitis
• Toxins
  • Mushroom toxicity
  • Crotinarius mushrooms
    • Gyromitra mushrooms
    • Amanita mushrooms
• Ischemic hepatitis
• Autoimmune hepatitis
• Wilson's disease

Evaluation

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

Management

• Treat underlying shock

Disposition

• Admit