Hypoxic hepatitis

Abstract

Hypoxic hepatitis (HH), an acute liver injury also known as 'ischaemic hepatitis' or 'shock liver', is frequently observed in intensive care units. HH is heralded by a massive but transient rise in serum aminotransferase activities caused by anoxic necrosis of centrilobular liver cells. Cardiac failure, respiratory failure and toxic-septic shock are the main underlying conditions accounting for more than 90% of cases, but HH may also occur in other circumstances. Until recently, liver ischaemia, i.e. a drop in hepatic blood flow, was considered the leading, and even the sole, hemodynamic mechanism responsible for HH, and it was generally held that a shock state was required. In reality, other hemodynamic mechanisms of hypoxia, such as passive congestion of the liver, arterial hypoxaemia and dysoxia, play an important role while a shock state is observed in only 50% of cases. Accordingly, 'ischaemic hepatitis' and 'shock liver' are misnomers. Therapy of HH depends primarily on the nature of the underlying condition. The prognosis is poor, with more than half of patients dying during the hospital stay.

Ischemic Hepatitis – Intercorrelated Pathology

“…Another characteristic of IH/HH is a higher level of plasma AST compared to ALT, as a direct result of higher concentration of AST in zone 3, the place where ischemic necrosis develops. There is a rapid decrease in AST plasma levels over 24-48 hours, whereas ALT takes longer (over one-two weeks) to return to normal (14).…”

“…(14). Cardiac output and hepatic blood flow are normal or even higher than normal, as opposed to chronic heart failure.…”

“…In patients with significant congestion and very low cardiac output, inotropes associated with diuretics (dobutamine plus furosemide) increase cardiac output, reduce liver (and systemic) congestion and improve hepatosplanchnic circulation (14). Cardiogenic or septic shock requires specific measures: inotropes and vasoconstrictors; oxygen optimization; interventional treatment in acute myocardial infarction; antibiotics.…”

Hypoxic hepatitis and acute liver failure in a patient with newly onset atrial fibrillation and diltiazem infusion

“…Pathologically, HH is characterised by centrilobular liver cell necrosis, which clinically manifests by a massive increase in serum aminotransferase 4 5. Generally, HH is preceded by an acute event that abruptly decreases the oxygen availability of the liver, in the presence of a pre-existing disease that causes chronic liver hypoxia 2 5.…”

Hypoxic-Ischemic Encephalopathy-Associated Liver Fatty Degeneration and the Effects of Therapeutic Hypothermia in Newborn Piglets

“…Ischemic hepatitis is characterized by centrilobular liver cell necrosis or fatty degeneration [8]. Therapeutic hypothermia has a protective effect against acute liver failure [9]; thus, we hypothesized that HIE-associated liver injury may also induce histopathological liver changes and that these changes may be ameliorated by therapeutic hypothermia.…”