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[Acute ischemic liver]

G Cellarier1, J Bonal, C Bouchiat

  • 1Service de Cardiologie, Hôpital d'Instruction des Armées Sainte-Anne, Toulon Naval.

Presse Medicale (Paris, France : 1983)
|October 21, 1995
PubMed
Summary
This summary is machine-generated.

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Acute ischaemic hepatitis, often seen in advanced heart failure, presents diagnostic challenges. Prompt recognition of elevated transaminases and clinical signs is crucial for managing this critical condition.

Area of Science:

  • Hepatology
  • Cardiology
  • Critical Care Medicine

Background:

  • Ischaemic hepatitis is an acute liver injury caused by hypoxia due to low cardiac output in patients with advanced congestive heart failure.
  • It is crucial to differentiate ischaemic hepatitis from other liver conditions like cardiac cirrhosis.

Observation:

  • Four elderly patients (79-86 years) with worsening heart failure presented with jaundice, oliguria, abdominal pain, and shock.
  • Key diagnostic indicators included a rapid, massive peak in transaminase levels (>20x normal) that normalized quickly, falling prothrombin and fibrinogen, and functional renal failure.

Findings:

  • Diagnosis of acute ischaemic hepatitis relies on characteristic enzyme fluctuations and the exclusion of other causes like viral hepatitis or drug toxicity.
  • Low cardiac output episodes can be easily overlooked, complicating the diagnosis.

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Implications:

  • Despite intensive care, mortality remains high (estimated 50% at 6 months), highlighting the severity of ischaemic hepatitis.
  • Needle biopsy is rarely indicated, primarily for cases with encephalopathy to rule out fulminant hepatitis.