title: Current concepts in ischemic hepatitis.
abstract: OBJECTIVE
  The 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.
  
  
  RESULTS
  Ischemic hepatitis has long been associated with cardiovascular disease; recent reports have found a substantial link between preexisting cardiovascular disease and the risk for developing ischemic hepatitis. A proposed mechanism by which hepatic congestion predisposes the liver to hemodynamic injury further defines this link. Treatment is aimed at the underlying hemodynamic disturbance; however, efforts to better predict mortality and improve outcomes continue to arise. The Acute Liver Failure Study Group proposed that, though uncommon, ischemic hepatitis may result in acute liver failure. With numerous studies identifying the multiple comorbid conditions associated with ischemic hepatitis, the sequela of acute liver failure is called into question.
  
  
  CONCLUSIONS
  Ischemic hepatitis is a clinical syndrome frequently encountered in critically ill patients that represents a complication of underlying cardiac, circulatory, or respiratory failure. The pathogenesis of ischemic hepatitis appears to occur as a result of a 'two-hit' mechanism when the liver, which is at risk, is subsequently exposed to systemic hypoperfusion and ischemia, ultimately resulting in a marked but transient elevation in aspartate aminotransferase and alanine aminotransferase. Mortality is high and is dependent largely on the underlying cause of hypotension. Treatment is directed at the underlying cause of hemodynamic disturbance.
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Lightsey
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D006505:Hepatitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008099:Liver / Q000098:blood supply*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase