Ischemic hepatitis

Also known as hypoxia hepatitis, or shock liver.

Results from any situation where hepatic blood flow is insufficient for hepatocyte survival.

Defined as a decrease in hepatic blood flow resulting in hepatocute death and necrosis.

It is commonly seen in critically ill patients.

In many cases a clear hypotensive episode is not documented, suggesting the insult maybe fleeting or sub clinical.

Characterized by transient rapid and massive increase in liver enzymes.

The elevation in aminotransferase levels are dramatic, but fall rapidly over 24-48 hours, followed by a rise in the bilirubin level.

Frequently related to hypotension.

Diagnosis often missed.

Liver blood flow about 25% of cardiac output.

Hepatic blood flow 2 sources: hepatic artery and portal vein.

Elevated central venous pressure and cardiac pressures on the right side are often important predisposing factors.

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