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Ischemic hepatitis in children: diagnosis and clinical course
J S Garland1, S L Werlin, T B Rice
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Insights
Pediatric ischemic hepatitis, caused by reduced liver blood flow, presents with high transaminases that normalize within days. This study defines its characteristics and outcomes in children, differentiating it from other hepatitis types.
Area of Science:
- Pediatrics
- Hepatology
- Critical Care Medicine
Background:
- Hepatic hypoperfusion can lead to ischemic hepatitis, a condition well-described in adults but less defined in pediatric populations.
- Ischemic hepatitis is characterized by a rapid increase in serum transaminases, followed by a return to near-normal levels within 7-10 days.
Purpose of the Study:
- To define the clinical presentation, biochemical characteristics, and outcomes of ischemic hepatitis in pediatric patients.
- To differentiate pediatric ischemic hepatitis from viral or drug-induced hepatitis based on clinical and biochemical data.
Main Methods:
- Retrospective case series of 22 pediatric patients diagnosed with ischemic hepatitis.
- Analysis of clinical data, including hypotensive episodes, pressor therapy, serum transaminase (SGOT) and bilirubin levels, coagulopathy, and mortality.
Main Results:
- Fifteen of 22 patients experienced documented hypotension or absent cardiac output prior to ischemic hepatitis.
- Marked elevation in SGOT levels (mean 2294 IU/L) with rapid decline within 9 days.
- Transient rise in bilirubin and coagulopathy in some patients; nine expired, but none from hepatic damage.
Conclusions:
- Ischemic hepatitis occurs in children during acute illnesses associated with diminished hepatic blood flow.
- The syndrome follows a characteristic clinical and biochemical course, aiding differentiation from other hepatitis etiologies.
- While serious, hepatic damage is not the primary cause of mortality in these pediatric cases.
Abstract:
Hepatic hypoperfusion can result in ischemic hepatitis, a clinical syndrome characterized by a sudden rise in serum transaminases followed by resolution to near normal levels within 7 to 10 days. Although described in adults, this syndrome has not been well defined in pediatric patients. We report 22 children who developed ischemic hepatitis during an acute illness. Fifteen of 22 patients had a documented hypotensive episode or no cardiac output before the onset of the ischemic hepatitis episode. Four of the seven patients without documented hypotension required pressor therapy to maintain their BP. SGOT showed a marked rise (mean 2294 IU/L, range 438 to 6652) from admission to 96 h (mean 34) with a rapid decline to near normal levels within 9 days (mean 5.1). Serum bilirubin levels also rose transiently, but generally not to the extent of transaminase levels. A clinically significant coagulopathy occurred in six patients. Although nine patients expired, none died as a direct result of the hepatic damage. Ischemic hepatitis can occur during illnesses associated with diminished hepatic blood flow and follows a characteristic course that usually can be differentiated from viral or drug-induced hepatitis on clinical and biochemical criteria.