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[Ischemic hepatitis. Case report].

Freddy Squella1, Rodrigo Zapata

  • 1Sección Gastroenterología, Departamento de Medicina Oriente, Facultad de Medicina, Universidad de Chile.

Revista Medica De Chile
|August 29, 2003
PubMed
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Ischemic hepatitis, or shock liver, occurs from reduced liver blood flow. This case shows rapid recovery of liver function tests after treating severe hypotension and heart arrhythmia.

Area of Science:

  • Hepatology
  • Cardiology
  • Critical Care Medicine

Background:

  • Ischemic hepatitis (shock liver) results from hepatocellular necrosis due to decreased hepatic perfusion from systemic hypotension.
  • Elevated serum aminotransferase levels (ALAT and ASAT) are characteristic, peaking within 1-3 days and normalizing in 7-10 days.
  • Histology shows centrolobular necrosis without inflammation.

Observation:

  • A 47-year-old woman with rheumatic mitral valve disease, atrial fibrillation, and congestive heart failure presented with rapid atrial arrhythmia and severe hypotension.
  • She developed progressive jaundice and markedly elevated aminotransferases (ALAT and ASAT) to ~100x upper normal limit.
  • Other causes of liver disease were excluded.

Findings:

  • The patient experienced rapid clinical improvement and normalization of liver function tests within 10 days.

Related Experiment Videos

  • This recovery was achieved with hemodynamic support and heart rate control.

    • Implications:

    • This case highlights the reversibility of ischemic hepatitis with prompt management of the underlying hemodynamic instability.
    • Effective treatment of cardiac emergencies can prevent or reverse severe liver injury.
    • Early recognition and intervention are crucial for favorable outcomes in shock liver patients.