(Acute liver infarction, hypoxic hepatitis, shock liver)

Ischemic hepatitis is a diffuse liver damage due to an insufficient supply of blood or oxygen

(See also Overview of vascular diseases of the liver.)

Ischemic hepatitis is a diffuse liver damage due to insufficient blood and oxygen supply (See also Overview of vascular diseases of the liver.) The causes are usually systemic Hepatic Perfusion (z. B. due to a reduced heart-time volume or systemic hypotension) hypoxemia (eg. as by respiratory failure or carbon monoxide poisoning) Increased metabolic demand (eg., by sepsis) Focal lesions of the liver vascular system are less frequent causative. Ischemic hepatitis can arise with sickle cell crisis at a thrombosis of the hepatic artery as part of a liver transplantation, or in a patient, wherein a thrombosis of the portal vein and the hepatic artery developed (which jeopardizes the double blood supply to the liver). The result is a central necrosis without inflammation (d. E. No proper hepatitis). The symptoms include nausea, vomiting and a druckdolente hepatomegaly. Diagnosis Clinical examination and liver function tests Color Doppler sonography aided or MRI angiography. Rare invasive angiography. In patients with risk factors and appropriate laboratory abnormalities suspected ischemic hepatitis is: The serum transaminases often rise dramatically to levels well above 1000 I.E./l. LDH rises within hours after ischemia (as opposed to acute viral hepatitis). The increase of serum bilirubin is moderate, mostly just to ? 4 times its upper limit of normal. PT / INR are increased. Diagnostic imaging helps define the cause: Using Doppler ultrasound, MRI or angiography may be a liver artery occlusion or portal vein thrombosis are diagnosed. Therapy liver reperfusion, the treatment is directed to the cause with the aim of restoring the perfusion, in particular by improving cardiac performance and assurance of hemodynamic stability. If the perfusion is restored, the transaminase levels about one to two weeks decrease again. In most cases, the liver function is fully restored. A fulminant hepatic failure is rare but can occur in patients with pre-existing cirrhosis.


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