Hepatic ischemia

Answer 1

Definition

Hepatic ischemia is a condition in which the liver does not get enough blood or oxygen, causing injury to liver cells.

Alternative Names

Ischemic hepatitis; Shock liver

Causes, incidence, and risk factors

Low blood pressure from any condition can lead to hepatic ischemia. Such conditions may include:

• Abnormal heart rhythms
• Dehydration
• Heart failure
• Infection
• Severe bleeding

Other causes may include:

• Large blood clots in the main artery to the liver (hepatic artery) after a transplant
• Swelling of blood vessels (vasculitis)

Symptoms

If low blood pressure continues for a long time, you may feel weak and lightheaded. However, the period of low blood pressure may be brief and produce no symptoms. Damage to the liver cells usually does not cause symptoms.

Signs and tests

Blood levels of liver enzymes, such as AST and ALT, typically rise 1 - 3 days after the episode of low blood pressure. Levels of another enzyme in the blood, LDH, are also usually high.

Treatment

Treatment depends on the cause of the low blood pressure. Low blood pressure must be treated so that the liver receives enough blood. The illness causing the problem must also be treated.

Expectations (prognosis)

Patients generally recover if the illness causing hepatic ischemia can be treated. Death from liver failure due to hepatic ischemia is very rare.

Complications

Liver failure is a rare but life-threatening complication.

Calling your health care provider

See your health care provider right away if you have persistent weakness or symptoms of shock or dehydration.

Prevention

Quickly treating the causes of low blood pressure may prevent hepatic ischemia.

References

Jain R, Thiele D. Gastrointestinal and hepatic manifestations of systemic diseases. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 34.

Answer 2

Definition

Hepatic ischemia is a condition in which the liver does not get enough blood or oxygen, causing injury to liver cells.

Alternative Names

Ischemic hepatitis; Shock liver

Causes, incidence, and risk factors

Low blood pressure from any condition can lead to hepatic ischemia. Such conditions may include:

• Abnormal heart rhythms
• Dehydration
• Heart failure
• Infection
• Severe bleeding

Other causes may include:

• Blood clots in the main artery to the liver (hepatic artery) after a liver transplant
• Swelling of blood vessels leading to reduced blood flow (vasculitis)

Symptoms

If low blood pressure continues for a long time, you may feel weak and lightheaded. However, the period of low blood pressure may be brief and produce no symptoms. Damage to the liver cells usually does not cause symptoms.

Blood clots in the liver's main artery may cause abdominal pain.

Signs and tests

The following tests will be done:

• Blood tests to check liver function (AST and ALT )
• Doppler ultrasound of the liver's blood vessels

Treatment

Treatment depends on the cause. Low blood pressure and blood clots must be properly treated.

Expectations (prognosis)

Patients generally recover if the illness causing hepatic ischemia can be treated. Death from liver failure due to hepatic ischemia is very rare.

Complications

Liver failure is a rare but life-threatening complication.

Calling your health care provider

See your health care provider right away if you have persistent weakness or symptoms of shock or dehydration.

Prevention

Quickly treating the causes of low blood pressure may prevent hepatic ischemia.

References

Jain R, Thiele DL. Gastrointestinal and hepatic manifestations of systemic diseases. In: Feldman M, Friedman LS, Brandt LJ eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 35.

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 146.

Reviewed By

Review Date: 07/07/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.