Sunday, August 21, 2016

Hypoxic hepatitis

An article on this topic recently appeared in The American Journal of Emergency Medicine. The paper focused on the post cardiac arrest situation but it is seen in other types of circulatory collapse. This entity has also been called ischemic hepatitis and shock liver. From the introduction of the paper:

Hypoxic hepatitis (HH) is frequently observed in critically ill patients and is associated with poor outcomes [1] . In HH, hypoperfusion with subsequent ischemia and passive congestion of the liver, severe systemic arterial hypoxemia, and/or impaired hepatic oxygen extraction induces centrilobular liver cell necrosis 2 3 4 5 . According to Henrion et al [2 6] , a diagnosis of HH could be clinically assumed if the following 3 conditions are met: (1) an appropriate clinical setting of cardiac, respiratory or circulatory failure; (2) a sharp increase in serum aminotransferase levels that reach at least 20 times the upper limit of normal; (3) the exclusion of other causes of acute liver cell necrosis, particularly viral or drug-induced hepatitis.

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