Acute hypoxic hepatitis (‘liver shock’): still a frequently overlooked cardiological diagnosis

Abstract

The diagnosis of acute hypoxic hepatitis remains problematic. We describe a series of 14 patients who were initially hospitalized in an hepatic care unit with a diagnosis of fulminant hepatitis, and were subsequently found to have acute hypoxic hepatitis ('liver shock') secondary to heart failure. A diagnostic algorithm is proposed.

The Incidence and Outcomes of Ischemic Hepatitis: A Systematic Review with Meta-analysis

“…Denis et al reported good outcomes following treatment with diuretics, inotropes or vasodilators,(43) agents that support cardiac function and relieve elevated filling pressures. The use of such interventions is likely reserved for the sickest patients.…”

Ischemic Hepatitis – Intercorrelated Pathology

“…Moreover, certain imaging findings may add incremental value to IH diagnostic in difficult cases such as dilation of hepatic veins and inferior vena cava (23). Liver ultrasound might reveal hepatic changes, e.g., liver masses, which are accompanied by elevated levels of aminotransferase or other enzymes.…”

Hepatic venous outflow obstruction: Three similar syndromes

“…Congestive hepatopathy may be missed in patients with heart failure and mild hepatic congestion, and in patients with overt hepatic congestion and vague cardiac symptoms [174,175] . Physicians should consider right-sided heart failure in patients with hepatomegaly with or without jaundice.…”