Shock liver is a state of decreased perfusion (blood flow) and/or passive congestion to the liver resulting in liver cell damage (necrosis) due to significant hypotension and/or hypovolemia. It is also known as ischemic hepatitis, acute hepatic infarction or hypoxic hepatitis. Generally, hepatitis is the inflammation of liver that is mostly seen in viral hepatitis or toxic hepatitis with an increase in liver enzymes; however, ischemic hepatitis shows an increase in liver enzymes without any liver inflammation.
Patients with shock liver shows signs of fatigue, weakness, nausea, vomiting, lightheadedness, liver tenderness, hepatomegaly, low urine output (oliguria) and mental confusion that might even lead to hepatic coma in rare cases. If patient has pre-existing liver cirrhosis then it might even lead to liver failure.
Is Shock Liver A Serious condition?
The answer whether shock liver is a serious condition or not is difficult to answer as shock liver is just a reaction to the underlying cause of the condition. The prevalence of shock liver is around 2.4 to 11% in intensive care unit (ICU), which is frequent in patients with critically ill diseases such as severe anemia, chronic pericardial constriction, cardiac arrest and shock. Whether shock liver becomes a serious condition or not depends totally on its treatment, which is completely based on the underlying cause. If the underlying cause is identified and treated immediately then shock liver also improves with time. When the underlying cause is a terminal disease then shock liver can be a serious condition and it might even lead to liver failure and death, but this is very rare. It is imperative to diagnose shock liver correctly as in most of the cases it can be misdiagnosed with toxic hepatitis (paracetamol poisoning) or viral hepatitis as in both these situations there is an elevation of LFT’s, thus these conditions should be ruled out while treating shock liver.
If shock liver is due to an infection, such as sepsis, then it can be treated with antibiotic therapy. If it is due to severe hypotension or dehydration, then it can be treated with IV fluids and diet modification with intake of adequate salt. If it is due to a blood clot then measures should be taken to remove or dissolve the blood clot. In most cases, shock liver resolves usually within 1 to 2 weeks of the treatment of underlying cause and does not present fatal.
Causes Of Shock Liver
Shock liver is caused due to impaired blood flow or oxygen and/or both to the liver. The most common cause of shock liver is the decreased blood flow throughout the body leading to decreased blood flow to the liver. Blood flow may be decreased in cases of heart failure, or sudden/acute large decrease in blood pressure due to either severe dehydration, profuse bleeding and/or a severe infection in the body. The decrease in oxygen level in the body may be contributed to severe respiratory disease, which might also lead to shock liver. There can also be an increased need of blood or oxygen in the body such as in sepsis that might also lead to shock liver.
Shock liver can also be caused by blocked blood vessel of liver including both hepatic artery and portal vein, due to either narrowing or blockage of the vessels. The most common cause of a blocked blood vessel is a blood clot, also known as thrombosis. Blood clots could be due to blood vessel injury such as in liver transplantation surgery, aneurysm of hepatic artery, vasculitis, sickle cell crisis, endocarditis, tumors and certain blood clotting disorders, either inherited or acquired.
Diagnosis Of Shock Liver
The diagnosis of shock liver is confirmed with the help of liver function tests, which will show abnormally increased levels of liver transaminase enzymes including both ALT and AST, which may exceed 10,000 U/L. Other tests include blood clotting tests along with imagings including ultrasound, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and arteriography of the liver’s blood vessels to determine any blood clot in hepatic vessels.
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