What Is The Best Medicine For Shock Liver?
What Is Shock Liver?
Shock liver is a state of decreased perfusion (blood flow) and/or passive congestion of liver resulting in liver cell damage (necrosis) due to significant hypotension and/or hypovolemia. It is also known as ischemic hepatitis 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 ischemic hepatitis show symptoms 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.
What Is The Best Medicine For Shock Liver?
This pathological condition is mostly seen in intensive care unit (ICU), cardiology or hepatology clinics, which is frequent in patients with critically ill diseases such as severe anemia, chronic pericardial constriction, cardiac arrest and shock. 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.
The best medicine for shock liver is that which treats the underlying cause responsible for liver dysfunction including severe heart failure, acute circulatory failure and respiratory failure. In addition, it is imperative to increase the flow of blood to the liver. As far as liver is concerned, the focus is paid on correction of hypoxia, increase oxygen supply and improve oxygen transport between blood and hepatic cells. The therapeutic measures at treating shock liver include correction of systemic hemodynamics by increasing cardiac output and arterial pressure along with adequate fluid replacement.
The focus and concern of treatment is acute or severe heart failure in shock liver. Inotropes along with diuretics (dobutamine and furosemide) can be given to patients with severe congestion and very low cardiac output, which reduces cardiac output, reduces liver as well as systemic congestion and improves liver circulation.
Septic shock requires treatment with antibiotics, inotropes and vasoconstrictors along with oxygen therapy.
Care must be taken when prescribing diuretics as these may further reduce blood volume, thus reducing hepatic perfusion and worsening shock liver. Excessive use of vasopressors such as norepinephrine in shock can also worsen shock liver.
The focus of shock liver treatment is improving liver perfusion along with oxygen therapy. The prognosis of shock liver depends on the underlying cause leading to shock liver. It may rarely lead to liver failure.
What Causes Shock Liver?
The most common cause of shock liver is decreased systemic blood flow leading to decreased blood flow to the liver. It may be decreased in cases of heart failure, or sudden/acute large decrease in blood pressure due to severe dehydration, profuse bleeding and/or severe infection in the body. The decrease in oxygen level in the body may be contributed to severe respiratory disease. There can also be an increased need of blood or oxygen in the body such as in sepsis.
Shock liver can also be caused by blocked blood vessel of liver including both hepatic artery and portal vein. The most common cause of a blocked blood vessel is a blood clot. 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.
How is Shock Liver Diagnosed?
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 IU/L. Other tests include blood clotting tests along with imaging tests 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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