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Related Experiment Videos

Ischaemic hepatitis in the elderly.

Khalid A Rashed1, W Robin McNabb, Roger R Lewis

  • 1Department of Geriatric and General Medicine, Guy's and St. Thomas' Hospital Trust, London, UK.

Gerontology
|June 8, 2002
PubMed
Summary
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Ischaemic hepatitis, a liver condition linked to cardiovascular events, occurs in 1% of elderly hospital patients. Prompt recognition and management are crucial, as a third of affected patients may die.

Area of Science:

  • Geriatric Medicine
  • Hepatology
  • Cardiology

Background:

  • Ischaemic hepatitis, characterized by centrilobular necrosis, is often associated with acute cardiovascular events.
  • It is considered rare in general hospitals but frequently unrecognized, impacting patient investigations and drug therapy.
  • Previous research has not specifically addressed ischaemic hepatitis in the elderly population.

Purpose of the Study:

  • To determine the incidence of ischaemic hepatitis in elderly patients admitted to a Geriatric Medicine department.
  • To assess the clinical and biochemical features of ischaemic hepatitis in this demographic.

Main Methods:

  • Prospective assessment of 1,905 consecutive elderly patients (age ≥65 years) over two years.
  • Diagnosis of ischaemic hepatitis based on rapid hepatocellular liver function test abnormalities in acutely ill patients with a blood pressure fall, excluding other causes.

Related Experiment Videos

  • Monitoring of blood pressure, daily liver and renal function tests, and prothrombin times during acute illness.

    • Main Results:

    • Ischaemic hepatitis developed in 19 patients (1%), most commonly linked to left ventricular failure.
    • Significant drops in blood pressure (systolic, diastolic, mean) were observed.
    • Marked elevations in alanine aminotransferase and lactic dehydrogenase were noted, with normalization within 7-22 days in survivors. Prolonged prothrombin times (>20s) occurred in 32% of patients.
    • Six patients died, primarily from left ventricular failure, with elevated creatinine and urea levels in non-survivors.

    Conclusions:

    • Ischaemic hepatitis is an uncommon but significant condition in acutely admitted elderly patients.
    • The study observed a dramatic rise in liver enzymes, which normalized within three weeks in survivors.
    • Clinical presentation was dominated by the underlying cause, and mortality was substantial, with one-third of patients dying.