From the Guidelines
Shock liver, also known as ischemic hepatitis, is a condition that occurs when the liver is not receiving enough blood flow, often due to cardiac arrest, hypovolemia, hypotension, or severe congestive heart failure.
Causes and Characteristics
- It can be caused by various factors, including cardiac dysfunction, hypotension, or hypoperfusion 1.
- Drug-induced hypotension or hypoperfusion may also contribute to the development of shock liver, with examples including long-acting niacin, cocaine, or methamphetamine 1.
- The condition is characterized by markedly elevated aminotransferase levels, which respond rapidly to stabilization of the circulatory problem 1.
- Renal dysfunction and muscle necrosis may also occur simultaneously 1.
Diagnosis and Management
- Hypoenhancement of the liver parenchyma may be observed on imaging studies, indicating hypoperfusion of the liver 1.
- Selective hepatic hypoperfusion due to hepatic arterial or portal venous occlusion can be reversible due to the liver's dual blood supply, but may result in liver failure or hepatic infarction 1.
- The ability to manage the underlying cause of ischemia, such as heart failure, will determine the outcome for these patients, and transplantation is seldom indicated 1.
From the Research
Definition of Shock Liver (Ischemic Hepatitis)
- Shock liver, also known as ischemic hepatitis or hypoxic hepatitis, is characterized by centrilobular liver cell necrosis and sharply increasing serum aminotransferase levels in a clinical setting of cardiac, circulatory, or respiratory failure 2, 3, 4, 5.
- It is an acute liver injury caused by hepatic hypoxia, with cardiac failure, respiratory failure, and septic shock being the main underlying conditions 3, 4, 5.
Pathophysiology and Clinical Presentation
- The pathophysiology of ischemic hepatitis is poorly understood, but it is believed to be the result of a reduction in systemic blood flow, as typically occurs in shock 6.
- Right-sided heart failure, with resultant hepatic venous congestion, may predispose the liver to hepatic injury induced by a hypotensive event 6.
- Other hemodynamic mechanisms of hypoxia, such as passive congestion of the liver, arterial hypoxaemia, and dysoxia, play an important role in the development of hypoxic hepatitis 4, 5.
Diagnosis and Prognosis
- The diagnosis of hypoxic hepatitis is primarily clinical and typically does not require liver biopsy 5.
- The prognosis is poor, with more than half of patients dying during the hospital stay 4, 5.
- Early recognition of hypoxic hepatitis and its underlying diseases, and subsequent initiation of therapy, is of central prognostic importance 2.
- The in-hospital mortality rate is >50%, and the most frequent cause of death is the predisposing condition and not the liver injury itself 5.
Treatment and Management
- Therapy of hypoxic hepatitis depends primarily on the nature of the underlying condition 4, 5.
- Successful management includes monitoring for potential complications such as hypoglycemia, hyperglycemia, hyperammonemia, and hepatopulmonary syndrome 2, 5.
- No specific therapies improving the hepatic function in patients with hypoxic hepatitis are currently established 2.