Ischemic hepatitis is damage throughout the liver caused by an inadequate blood or oxygen supply.

• Heart or respiratory failure may reduce the blood flow or oxygen supply to the liver.
• People feel nauseated and vomit; the liver may be tender and enlarged.

In ischemic hepatitis, liver cells are damaged or die because the liver does not receive enough blood or oxygen.

Ischemic hepatitis differs from other types of hepatitis. Usually, “hepatitis” implies inflammation of the liver, which can have many causes, most commonly a virus (as in hepatitis A or B). In ischemic hepatitis, however, the liver is not inflamed; rather liver cell death (necrosis) occurs. It is termed hepatitis because, as in viral and other types of hepatitis, liver enzymes called aminotransferases leak from damaged liver cells into the blood.

Causes

For ischemic hepatitis to develop, the liver's requirements for blood, oxygen or both are not being met. The most common cause for such unmet needs is when blood flow throughout the body decreases. Causes include the following:

• Heart failure
• Respiratory failure
• Shock
• Massive bleeding
• Severe dehydration

A severe infection that affects all or most of the body, such as sepsis, can increase the liver's need for oxygen and thus contribute to ischemic hepatitis.

Because the liver receives blood from the hepatic artery and portal vein, narrowing or blockage of one of these vessels does not usually cause ischemic hepatitis. This disorder results when blood flow in both vessels is reduced or blocked. The most common cause of blocked blood vessels is a blood clot. (Blockage by a blood clot is termed thrombosis.) Blood clots in the hepatic artery can have many causes, such as the following:

• Injury of blood vessels (as occurs during liver transplantation surgery)
• Aneurysms of the hepatic artery
• Inflammation of the artery (vasculitis)
• Use of cocaine (causing spasm of the artery)
• Tumors, certain medical procedures, or heart infections (endocarditis) that cause emboli—clumps of material, such as a piece of fatty material or blood clot on the wall of an artery—to break off and travel through the bloodstream and become lodged in a blood vessel

Disorders that make blood more likely to clot (blood clotting disorders) can cause blockages in arteries or veins. These disorders may be inherited or acquired.

Symptoms and Diagnosis

Symptoms include nausea and vomiting. The liver may be tender and enlarged.

Doctors suspect ischemic hepatitis when results of liver biochemical and blood clotting tests are abnormal, especially in people who have a condition that can cause the disorder. Blockage of the hepatic artery can be detected using ultrasonography, magnetic resonance angiography, or x-rays taken after a radiopaque dye (which is visible on x-rays) is injected into an artery (arteriography).

Treatment

Doctors focus on treating the condition that is reducing blood flow to the liver. If blood flow can be restored, ischemic hepatitis commonly resolves. Liver failure can occur if people already have severe scarring of the liver (cirrhosis).

Last full review/revision December 2007 by Eldon A. Shaffer, MD