31st July 2023

Ischaemic Hepatitis

A cause of acute liver failure secondary to insufficient perfusion to the liver. This is frequently due to systemic hypotension, though it can rarely be caused by a clot in the hepatic artery or significant activation of the renin-angiotensin system, which results in splanchnic vasoconstriction. The condition is often termed ‘shock liver’ and is commonly a result of septic, hypovolaemic, cardiogenic or other types of shock. Therefore, it is very likely that there will be concurrent damage to other end organs that are sensitive to ischaemia, such as the kidneys and brain.

The patient may present with jaundice and features of hepatic encephalopathy, such as confusion and asterixis. However, the diagnosis is usually made on the basis of a marked increase in aminotransferase levels after an inciting event. The differential for a very high ALT level (>1000 IU/L) includes paracetamol overdose and acute viral hepatitis, and these should be excluded.

Treating the underlying cause of the ischaemia is the mainstay of management, and critical care support may be required to restore and maintain adequate blood pressure.

The typical histopathological findings of the liver at post-mortem are centrilobular necrosis with normal periportal hepatocytes.