Ischemic hepatitis

People who develop ischemic hepatitis may have weakness, fatigue, mental confusion, and low urine production (oliguria). A small percentage of affected people may develop hepatic coma. Yellow discoloration of the skin (jaundice) can occur, but is rare and temporary, as is actual loss of function of the liver.{{Cite book|title = Liver: A Complete Book on Hepato-Pancreato-Biliary Diseases|url = https://books.google.com/books?id=INdnJOKb-F0C&dq=Ischemic%2520hepatitis%2520%2520symptoms&pg=PT422|publisher = Elsevier India|date = 2009-01-01|isbn = 9788131216743}}

File:Ventricular fibrillation.png

Ischemic hepatitis can be caused by a number of reasons (that lead to low blood pressure) including:{{Cite web|title = Hepatic ischemia: MedlinePlus Medical Encyclopedia|url = https://www.nlm.nih.gov/medlineplus/ency/article/000214.htm|website = www.nlm.nih.gov|accessdate = 2015-08-24}}

• Abnormal heart rhythm
• Heart failure
• Infection
• Hypovolemic shock (e.g., due to profuse bleeding)
• Blood clots (hepatic artery after surgery)

The mechanism of ischemic hepatitis depends on the etiopathogenetic origin, be it a cardiomyopathy, cardiac tamponade, trauma, or bleeding.{{Cite book|title = Textbook of Pediatric Gastroenterology, Hepatology and Nutrition|url = https://books.google.com/books?id=NXkHCgAAQBAJ|publisher = JP Medical Ltd|date = 2015-04-30|isbn = 9789351527404|first1 = Anupam|last1 = Sibal|first2 = Sarath|last2 = Gopalan}} Usually ischemic hepatitis reveals itself after a hypotensive event with increased levels of aminotransferases.{{Cite book|title = Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables|url = https://books.google.com/books?id=DdBJ6jCf8KgC|publisher = Springer Science & Business Media|date = 2009-03-19|isbn = 9783540671367|first = Florian|last = Lang}} Because of this, hypotension is thought to be one of the primary insults leading to ischemic hepatitis.{{Cite book|title = Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features|url = https://books.google.com/books?id=zEZOqB6r9hwC|publisher = Elsevier Health Sciences|date = 2010-05-03|isbn = 978-1437727678|first1 = Mark|last1 = Feldman|first2 = Lawrence S.|last2 = Friedman|first3 = Lawrence J.|last3 = Brandt}}

File:Congestive hepatopathy high mag.jpg

Blood testing usually shows markedly high elevations of both liver transaminase enzymes, AST and ALT, which may exceed 10,000 U/L.{{cite journal |vauthors=Raurich JM, Pérez O, Llompart-Pou JA, Ibáñez J, Ayestarán I, Pérez-Bárcena J |title=Incidence and outcome of ischemic hepatitis complicating septic shock |journal=Hepatology Research |volume=39 |issue=7 |pages=700–5 |date=July 2009 |pmid=19473435 |doi=10.1111/j.1872-034X.2009.00501.x |s2cid=20312771 }} It has been found that those who suffer from ischemic hepatitis had significant cardiac disease as well.{{Cite book|title = Zakim and Boyer's Hepatology: A Textbook of Liver Disease|url = https://books.google.com/books?id=zjYof6MJZkkC|publisher = Elsevier Health Sciences|date = 2012-01-01|isbn = 978-1437708813|first1 = Thomas D.|last1 = Boyer|first2 = Michael Peter|last2 = Manns|first3 = Arun J.|last3 = Sanyal|first4 = David|last4 = Zakim}}

As a measure of precaution, paracetamol levels and a toxicology screening should be completed to evaluate for possible toxin-mediated injury; it is also imperative to be able to exclude the possibility of acute viral hepatitis.{{Cite book|title = Zakim and Boyer's Hepatology: A Textbook of Liver Disease|url = https://books.google.com/books?id=zjYof6MJZkkC|publisher = Elsevier Health Sciences|date = 2012-01-01|isbn = 978-1437708813|first1 = Thomas D.|last1 = Boyer|first2 = Michael Peter|last2 = Manns|first3 = Arun J.|last3 = Sanyal|first4 = David|last4 = Zakim}}

Ischemic hepatitis is related to another condition called congestive hepatopathy. Congestive hepatopathy includes a number of liver disorders that occur in right-sided heart failure. The medical term congestive hepatopathy is used, however, the term cardiac cirrhosis is convention. These two entities can coexist in an affected individual.{{Cite journal|title = Cardiac Cirrhosis and Congestive Hepatopathy: Background, Pathophysiology, Epidemiology|url = http://emedicine.medscape.com/article/151792-overview|date = 2018-06-28}}

The treatment of ischemic hepatitis is as follows:{{Cite book|title = Trauma: Critical Care|url = https://books.google.com/books?id=3H3AIEtvc8YC|publisher = CRC Press|date = 2007-02-05|isbn = 9781420016840|first1 = William C.|last1 = Wilson|first2 = Christopher M.|last2 = Grande|first3 = David B.|last3 = Hoyt}}

{{columns-list|colwidth=30em|

• Antibiotic treatment if a bacterial infection causing septic shock is present
• Restore and maintain adequate blood pressure
• Medication
• Control any gastrointestinal bleeding

}}

• Elevated transaminases

{{Reflist}}

• {{Cite book|title = Textbook of Organ Transplantation Set|url = https://books.google.com/books?id=GzMWBAAAQBAJ|publisher = John Wiley & Sons|date = 2014-07-21|isbn = 9781118889626|first1 = Allan D.|last1 = Kirk|first2 = Stuart J.|last2 = Knechtle|first3 = Christian P.|last3 = Larsen|first4 = Joren C.|last4 = Madsen|first5 = Thomas C.|last5 = Pearson|first6 = Steven A.|last6 = Webber}}
• {{Cite book|title = Manual of Intensive Care Medicine|url = https://books.google.com/books?id=1NcPIAHykxAC|publisher = Lippincott Williams & Wilkins|date = 2012-03-28|isbn = 9781451149074|first1 = Richard S.|last1 = Irwin|first2 = James M.|last2 = Rippe}}

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|K72.0}}

| ICD9 =

| ICDO =

| OMIM =

| MedlinePlus = 000214

| MeSH =

| GeneReviewsNBK =

| GeneReviewsName =

}}

{{Commons}}

{{Scholia|topic}}

{{Digestive system diseases}}

{{Medicine}}

Category:Hepatitis