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[Ischemic hepatitis].

J M van Riel¹, A L Kerremans

¹Elkerliek Ziekenhuis, afd. Interne Geneeskunde, Helmond.

Nederlands Tijdschrift Voor Geneeskunde

|October 17, 1992

Summary

Ischaemic hepatitis, or shock liver, is a frequent cause of severely elevated liver enzymes in hospitalized patients. Diagnosis is straightforward based on clinical signs and lab results, with an excellent prognosis when the underlying cause is treated.

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Area of Science:

Hepatology
Critical Care Medicine
Clinical Biochemistry

Background:

Ischaemic hepatitis (shock liver) is a critical condition often associated with severe respiratory insufficiency.
Information on the clinical characteristics and incidence of ischaemic hepatitis is surprisingly scarce in major medical literature.
This study aimed to determine the incidence and diagnostic features of ischaemic hepatitis in a general hospital setting.

Observation:

A nine-month study identified 27 adult patients with peak alanine aminotransferase (ALAT) levels > 500 U/l.
Eight patients were diagnosed with ischaemic hepatitis, and five others had suspected cases.
Biochemical profiles showed markedly elevated aspartate aminotransferase (ASAT), ALAT, and lactate dehydrogenase (LDH) levels (8-100 times normal).

Findings:

Ischaemic hepatitis was the most common cause of severely elevated ASAT, ALAT, and LDH among hospitalized patients.
Key diagnostic indicators include characteristic clinical presentation and a specific biochemical pattern (markedly elevated aminotransferases and LDH, with minimally abnormal bilirubin and alkaline phosphatase).
Liver enzyme levels normalized rapidly (5-10 days) upon correction of the underlying disorder.

Implications:

Ischaemic hepatitis can be reliably diagnosed using clinical and biochemical data, obviating the need for extensive workups or invasive procedures.
The condition is easily distinguishable from other forms of hepatitis, such as alcoholic, viral, or drug-induced hepatitis.
While the prognosis for ischaemic hepatitis itself is excellent, overall patient outcomes depend critically on managing the primary underlying condition.

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