Hypoxic hepatitis: the point of view of the clinician

Hypoxic hepatitis better known under the terms of ischemic hepatitis or shock liver is the clinical manifestation of an acute liver cell necrosis consecutive to liver hypoxia. The clinical syndrome is defined as a massive but rapidly resolutive increase in serum aminotransferase activities (AT) occurring in a clinical setting of hemodynamic failure. Actually, when confronted to a case of massive increase in serum AT in the setting of cardiac or respiratory failure, the diagnosis of HH may be assumed without liver biopsy if another cause of hepatocyte necrosis such as viral hepatitis or drug induced hepatitis may be excluded. To our opinion, in these patients often aged and in poor general condition, it is particularly important to exclude herpes simplex virus infection and paracetamol intoxication. In case of doubt, a mere ultrasonography of the liver will be helpful. Indeed the majority of these patients will have a dilation of hepatic veins due to passive congestion of the liver. There is no specific liver therapy and the prognosis is poor depending on the severity of the underlying condition. In this point of view, we report what could be of interest for the hospital clinician.