ischemic hepatitis
Introduction
Introduction to ischemic hepatitis Ischemic hepatitis refers to reversible severe hypotension and hypoxemia leading to central necrosis of the liver lobules, often caused by congestive heart failure, shock, liver trauma and cardiac surgery, causing cardiogenic or hypovolemic shock, especially It is related to liver reperfusion injury after shock. The clinical manifestations were similar to acute hepatitis, and alanine aminotransferase (ALT) continued to increase significantly, but there was no evidence of hepatitis virus infection and hepatic toxicity to disease removal. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: congestive heart failure, shock
Cause
Causes of ischemic hepatitis
Cause:
The cause is not clear.
Prevention
Ischemic hepatitis prevention
Most patients are reversible, may be related to the complete existence of the hepatic lobular reticular stent after hepatic necrosis and as a template for hepatocyte proliferation. The disease rarely occurs in liver failure, and the mortality rate is often determined by the primary underlying disease.
Complication
Ischemic hepatitis complications Complications, congestive heart failure, shock
The disease is complicated by congestive heart failure, shock, liver trauma and heart disease.
Symptom
Ischemic hepatitis symptoms common symptoms arrhythmia jaundice liver atrophy upper abdomen discomfort hypotension liver enlargement myocardial infarction loss of appetite
First, the performance of basic diseases
This disease is more common after cardiac surgery, especially the artificial valve replacement of multiple valves at the same time, acute myocardial infarction and severe arrhythmia caused by left heart failure, severe infection and sepsis, etc., occasionally on the basis of chronic liver disease Hemorrhage in the digestive tract, the above factors can cause a significant reduction in liver blood supply, but has little to do with liver congestion.
Second, acute hepatitis-like performance
Ischemic hepatitis may also have loss of appetite, right upper quadrant discomfort and pain, jaundice and liver enlargement, but more characteristic and more common are serum ALT and AST (aspartate aminotransferase) increased significantly, Up to 10 times normal, the onset rises within 1 to 3 days, and falls rapidly to normal within 8 days. At the same time, blood bilirubin, alkaline phosphatase, lactate dehydrogenase (LDH) increase, and LDH rises. It can be caused by myocardial infarction. Therefore, the obvious increase of LDH isoenzyme (LDH5) is more diagnostic value for ischemic hepatitis.
Examine
Examination of ischemic hepatitis
Blood routine, X-ray, CT, etc.
Diagnosis
Diagnosis and diagnosis of ischemic hepatitis
diagnosis
The diagnosis of this disease should have the following indicators:
1. ALT occurred within 3 days after severe hypotension, and AST increased significantly and continuously;
2. Excluding acute myocardial infarction in the near future;
3. Lack of serological markers of hepatitis virus infection and exclusion of liver damage caused by toxins and chemicals.
Differential diagnosis
Acute viral hepatitis
The disease can be detected by detecting the patient's serum hepatitis markers, such as A, B, C or even hepatitis D virus antigens or antibodies, or nucleic acid molecules (PCR method), but ischemic in patients with viral disease Hepatitis has certain difficulties. Aminotransferase (ALT, AST) in patients with ischemic hepatitis usually rises rapidly 48 hours after onset, and it usually changes within 5 to 10 days, while viral hepatitis changes slowly, ischemic hepatitis. LDH is significantly elevated, while viral hepatitis is only slightly elevated or not elevated, and liver biopsy can be identified by pathological examination.
2. Acute myocardial infarction
Serum enzymology changes can also occur in this disease, but its typical angina symptoms, electrocardiogram changes in the body and muscle are not difficult to identify with ischemic hepatitis, if necessary, check creatine phosphokinase isoenzyme (CPK-MB) and LDH1 help For diagnosis.
The treatment of this disease is to maintain proper cardiac output, positive and strong diuretic can further reduce blood volume, increase liver ischemia and further reduce blood volume, increase liver ischemia and promote hepatocyte necrosis. Dopamine can increase liver blood flow and has a cardiotonic effect. Other drugs for preventing and treating shock/reperfusion liver injury are still in the experimental stage.
