The Experts below are selected from a list of 1119 Experts worldwide ranked by ideXlab platform
Don C. Rockey - One of the best experts on this subject based on the ideXlab platform.
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current concepts in Ischemic Hepatitis
Current Opinion in Gastroenterology, 2017Co-Authors: Joseph M Lightsey, Don C. RockeyAbstract:Purpose of reviewThe current review seeks to define Ischemic Hepatitis and its associated comorbidities. It means to review the pathophysiology, clinical presentation, clinical course, outcomes, and any potential therapies.Recent findingsIschemic Hepatitis has long been associated with cardiovascula
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Ischemic Hepatitis as the presenting manifestation of cardiac amyloidosis
Journal of investigative medicine high impact case reports, 2014Co-Authors: Chelsey A Petz, Thomas M Todoran, Don C. RockeyAbstract:An abrupt elevation in aminotransferases without clear etiology may be attributed to hypoxic Hepatitis. Underlying cardiac dysfunction, an important clinical clue, is often overlooked as a cause of hypoxic Hepatitis, and understanding the interdependence of the heart and liver is crucial in making this diagnosis. Causes of cardiac dysfunction may include any of many different diagnoses; infiltrative heart disease is a rare cause of cardiac dysfunction, with amyloidosis being the most common among this category of pathologies. More advanced imaging techniques have improved the ability to diagnose infiltrative heart disease, thus allowing quicker diagnosis of conditions such as amyloidosis.
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Ischemic Hepatitis : clinical presentation and pathogenesis
The American journal of medicine, 2000Co-Authors: Reginald K. Seeto, Ben Fenn, Don C. RockeyAbstract:Abstract BACKGROUND: The pathophysiology of Ischemic Hepatitis, otherwise known as "shock liver," is poorly understood, although it is believed to be the result of a reduction in systemic blood flow as typically occurs in shock. The aim of this study was to investigate the importance of this phenomenon as well as other clinical features in patients with Ischemic Hepatitis. METHODS: We identified a cohort of 31 patients (case group) who met the most commonly accepted definition of Ischemic Hepatitis (an acute reversible elevation in either the serum alanine or aspartate aminotransferase level of at least 20 times the upper limit of normal, excluding known causes of acute Hepatitis or hepatocellular injury, in an appropriate clinical setting). We also evaluated the clinical features and serum aminotransferase levels in a cohort (the control group) of 31 previously healthy patients who sustained major nonhepatic trauma at San Francisco General Hospital, a major trauma center. Both groups of patients had documented systolic blood pressures RESULTS: Despite the marked reduction in blood pressure, no patient in the control group developed Ischemic Hepatitis. The mean (± SD) peak serum aspartate aminotransferase level in the control group was only 78 ± 72 IU, in contrast with a mean peak of 2,088 ± 2,165 IU in the case group. All 31 patients with Ischemic Hepatitis had evidence of underlying organic heart disease, 29 (94%) of whom had right-sided heart failure. CONCLUSIONS: Systemic hypotension or shock alone did not lead to Ischemic Hepatitis in any patient. The vast majority of patients with Ischemic Hepatitis had severe underlying cardiac disease that had often led to passive congestion of the liver. These data lead us to propose that right-sided heart failure, with resultant hepatic venous congestion, may predispose the liver to hepatic injury induced by a hypotensive event.
Lawrence S Friedman - One of the best experts on this subject based on the ideXlab platform.
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the liver in heart failure
Clinics in Liver Disease, 2002Co-Authors: Cosmas Giallourakis, Peter M Rosenberg, Lawrence S FriedmanAbstract:Severe congestive heart failure is associated with two distinct forms of liver dysfunction: jaundice that is related to passive congestion and acute hepatocellular necrosis that is caused by impaired perfusion. Cardiac cirrhosis (fibrosis) may result from prolonged recurrent congestive heart failure. Ischemic Hepatitis (shock liver) usually manifests as asymptomatic elevation of the serum aminotransferase levels after an episode of hypotension, although the clinical presentation may mimic that of acute viral Hepatitis. In most cases, Ischemic Hepatitis is of little clinical consequence and is self-limited. Acute liver failure may occur in patients with preexisting cirrhosis, severe chronic heart failure, or sustained hepatic ischemia.
Eric Lopezmendez - One of the best experts on this subject based on the ideXlab platform.
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a 57 year old man with chronic renal failure and cardiac tamponade who developed Ischemic Hepatitis
Annals of Hepatology, 2006Co-Authors: Eric Lopezmendez, Ivan Lopezmendez, Pablo Hernandezreyes, Jaime Galindouribe, Vanessa Anguloramirez, Lourdes Avilaescobedo, Misael UribeAbstract:Ischemic Hepatitis is an infrequent entity, usually associated with low cardiac out put. We present a case of a 57 year-old man with chronic renal failure and cardiac tamponade who developed elevation of serum alanine transferase level of 5,054 U/L, aspartate transferase level of 8,747 U/L and lactate dehydrogenasa level of 15,220 U/L. The patient developed hepatic encephalopathy and hypoglycemia. Liver Doppler ultrasound was normal. He was seronegative for HBV and HCV, drugs list was scrutinized for the names of known hepatotoxins. Ischemic Hepatitis was diagnosed. The hypoglycemia and encephalopathy were solved and the patient was discharged with normal transaminase levels. Ischemic Hepatitis is typically preceded by hypotension, hypoxemia, or both. As one would expect, the most common cause of sustained systemic hypotension is cardiovascular disease. Liver biopsy is usually not necessary. The best treatment is support measures and correct the underlying condition.
K Spiropoulos - One of the best experts on this subject based on the ideXlab platform.
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a case of Ischemic Hepatitis
Sleep and Breathing, 2004Co-Authors: Georgia Trakada, Charis Gogos, M Tsiamita, Dimitris Siagris, Panagiotis Goumas, K SpiropoulosAbstract:We present a case of an obese young man who developed Ischemic Hepatitis, severe coagulopathy, acute renal failure, and encephalopathy. Heart failure and hypovolemia were absent. Oxygen arterial saturation was very low, between 77% and 99% during the day, with no history of respiratory failure. A diagnosis of obstructive sleep apnea was made clinically and confirmed by performing formal polysomnography. The polysomnographic study showed multiple episodes of apneas and hypopneas with severe oxygen desaturation. The patient was treated with continuous positive airway pressure through a nose mask and clinical manifestations related to profound nocturnal desaturation were ameliorated. He was discharged 32 days after admission with normal results of laboratory tests. This case report is presented to support the hypothesis that hypoxic Hepatitis was directly related to severe arterial hypoxemia.
F R Heller - One of the best experts on this subject based on the ideXlab platform.
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hypoxic Hepatitis caused by acute exacerbation of chronic respiratory failure a case controlled hemodynamic study of 17 consecutive cases
Hepatology, 1999Co-Authors: J Henrion, Lucien Colin, M Schapira, Philippe Minette, Andre Delannoy, F R HellerAbstract:Out of a prospective series of 142 consecutive episodes of hypoxic (Ischemic) Hepatitis (HH), we identified 17 episodes associated with an acute exacerbation of chronic respiratory failure (CRF) without left cardiac failure. In the aim to evaluate the role of arterial hypoxemia in the pathogenesis of HH associated with respiratory failure, these 17 episodes of HH (study group) were hemodynamically compared with a control group of 17 episodes of HH associated with congestive heart failure (CHF) (control group 1) and a group of 16 episodes of acute respiratory failure (ARF) not complicated by HH (control group 2). Arterial hypoxemia was significantly more severe in the study group (arterial blood tension in O2[Pao2], 34 mm Hg) than in control group 1 (Pao2, 70 mm Hg; P < .0001) and control group 2 (Pao2, 45.5 mm Hg; P = .002). The role of arterial hypoxemia, however, appeared weakened by comparable degrees of systemic hypotension and liver passive congestion in episodes of HH associated with CRF and episodes of HH associated with CHF. Finally, the causative role of arterial hypoxemia emerged from hemodynamic measurements of cardiac index (CI), systemic vascular resistances (SVR), and oxygen transport: systemic hypotension in HH associated with CHF (control group 1) was the result of a fall in CI (median, 2.33 L/min · m2; range, 1.21-3.14 L/min · m2) associated with high SVR (median, 2,492 dyn · s/cm5 · m2; range, 1,382-4,053 dyn · s/cm5 · m2), whereas in HH associated with respiratory failure (study group), systemic hypotension was the result of a fall in SVR (median, 1,053 dyn · s/cm5 · m2; range, 646-3,148 dyn · s/cm5 · m2), resulting in high CI (median, 4.23 L/min · m2; range, 1.9-5.32 L/min · m2) (P = .0087 and .0038 for cardiac index and SVR, respectively). Moreover, measurements of oxygen transport in patients with HH associated with respiratory failure showed low values of O2 delivery (Do2) (median, 376 mL/min · m2; range, 253-427 mL/min · m2) as a result of extreme arterial hypoxemia despite high CI. In conclusion, these hemodynamic results and additional measurements of hepatic blood flow (HBF) by the method of galactose clearance at a low concentration suggest that in the setting of HH associated with respiratory failure, the liver is not “Ischemic,” despite hypotension, but rather “hypoxic” as a result of the combination of severe arterial hypoxemia and elevated central venous pressure (CVP)
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Ischemic Hepatitis in cirrhosis rare but lethal
Journal of Clinical Gastroenterology, 1993Co-Authors: Jean Henrion, Lucien Colin, Albert Schmitz, M Schapira, F R HellerAbstract:We report two cases of Ischemic Hepatitis in patients with alcoholic cirrhosis. In both, hepatic ischemia was induced by hemorrhagic shock and severe sepsis. Despite control of the bleeding and restoration of normal hemodynamics, liver failure deteriorated to hepatic coma and death in both cases. Ischemic Hepatitis occurred in 1.5% of 130 consecutive cases of cirrhosis admitted for hemorrhage on our medical intensive care unit. Although cirrhotic patients run an increased risk of Ischemic Hepatitis, our experience and our review of the literature indicate that this condition is rare in these patients.
