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Ischemic hepatitis in cirrhosis. clinical features and prognostic implications
T Kamiyama1, H Miyakawa, K Tajiri
1Second Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
Journal of Clinical Gastroenterology
|March 1, 1996
Summary
Patients with cirrhosis and esophageal variceal bleeding experiencing shock face a high risk of liver dysfunction. Early detection of elevated bilirubin and aminotransferase levels within 24 hours is crucial for guiding patient management.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Cirrhosis commonly leads to esophageal varices, which can cause life-threatening bleeding.
- Variceal bleeding, particularly with shock, poses a significant risk for developing liver dysfunction.
Purpose of the Study:
- To investigate the characteristics of liver dysfunction in cirrhotic patients following variceal bleeding.
- To identify early indicators of severe liver injury in this patient population.
Main Methods:
- Analysis of 50 cirrhotic patients with bleeding esophageal varices, with or without shock.
- Monitoring serum total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels within 24 hours of hemorrhage onset.
- Examination of postmortem liver tissues for histopathological changes.
Main Results:
- Elevated serum total bilirubin (>1.5 times) within 24 hours was significantly associated with mortality in patients with shock (11/12 deaths vs. 1/8 survivors, p < 0.01).
- Increased serum aspartate aminotransferase and alanine aminotransferase (>2.5 times) within 24 hours occurred in 6 patients who died versus none who survived (p < 0.05).
- Postmortem liver analysis revealed hepatocellular degeneration consistent with ischemic hepatitis.
Conclusions:
- Ischemic hepatitis is a frequent complication in cirrhotic patients with ruptured esophageal varices and shock.
- Early increases in serum bilirubin and aminotransferases after hemorrhage onset warrant vigilant monitoring and careful management, even if bleeding is controlled.