Reviewed By: Pramod Kerkar, MD, FFARCSI

The liver is the largest organ and has a vital role in maintaining the physiological processes in the body. It is an extremely vital parenchymal organ as it has blood movement from two parts which are the hepatic artery and portal vein. It is the place of active metabolism, clearance of waste and significant blood volume reservoir. Any interrupt to the normal function of the liver can induce the deleterious effect in the human body.

What is the Main Cause of Shock Liver?

What is The Main Cause of Shock Liver?

Shock liver also referred as “ischemic hepatitis,” occurs mainly because of reduction in systemic blood flow in the liver. This condition is called “hepatocytes hypo-perfusion”, which causes liver injury. It is as a result of hemodynamic instability and reduced blood flow as the blood is not able to pass smoothly through the hepatic arteries, and passive venous congestion. This is observed in most of the heart failure cases. Another factor inducing shock liver is a condition called Hypoxic Hepatitis which is caused due to other conditions like respiratory failure. It is also known by the name of hypoxic hepatopathy. Hypoxic hepatitis and ischemic hepatitis all refers the condition shock liver.

In shock liver, abnormal level of hepatic enzymes is observed. Aminotransferases and bilirubin levels are usually in mild elevated level and become high after hemodynamic shock. The abnormal elevation of bilirubin and liver enzymes can worsen the condition within a few days if there is consistent failure of the hepatic microcirculatory system.

In many cases, liver dysfunction occurs without any conspicuous symptoms in affected individuals. Several factors can induce liver shock like a major surgical procedure, respiratory failure, hemorrhage, underlying infections, and persistent shock. Systemic failure of microcirculation, poor inflammatory response and adverse effects of treatment in patients in intensive care unit are some of the factors also causes liver shock.

There are multiple causes of low blood pressure, also called hypotension, which can lead to hepatic ischemia. The majority of the cases available in the scientific publication discuss the cardiac failure underlying hypoxic hepatitis, ranging from 39–70%. The conditions of cardiac failure resulting in a low output state, sepsis, and respiratory failure together account for >90% of cases. In the recent meta-analysis study, 78% of hypoxic hepatitis cases were found to be caused by an acute cardiac event. Patients are especially at risk when there is passive congestion of the liver related to right-sided heart failure.

Most prevalent among the other risk factors was the condition of septic shock. It is the result of an infection that causes drastic changes in the body. Some literature says that septic shock was identified in 32% of patients suffering from hypoxic hepatitis and was the leading cause of death. Some of the other preconditions which have been well documented in literatures are anemia, peritonitis, hypovolemic shock, extensive burns, blackwater fever, and sleep apnea. Overdose of certain medications can also lead to ischemic hepatitis like phenacetin, NSAIDs, antimicrobials, and halothane anaesthetics. Sulfa medications also tend to cause ischemic hepatitis.

Multiple factors are responsible for the development of ischemic hepatitis. Development of jaundice in patients suffering from severe trauma or surgery is one of the serious factors. A blood transfusion can cause an increase in bilirubin load, the hematomas tend to get reabsorbed, and there may also be sepsis. Any sort of trauma, a surgical procedure, administration of certain medications, TPA, and ischemia/hypoxia as a result of shock may all lead to impaired hepatocellular function. Rarely cholestastic jaundice may develop. Clinical presentation of ischemic hepatitis mimics that of acute viral hepatitis with significant elevation of ALT, AST and LDH but alkaline phosphatase, bilirubin, and PTT are marginally abnormal. The liver function returns to normal within 5 to 10 days with correction of the underlying cause.

Conclusion

Liver shock is also known as ischemic hepatitis, which is caused by insufficient blood flow and insufficient oxygen delivery to the liver. The decrease of blood flow to the liver is normally a result of shock or hypotension. Multiple factors are responsible for the development of ischemic hepatitis such as heart failure, respiratory failure, infection like viral hepatitis, blood clots after surgery, drugs, and toxin-mediated liver damage. The condition usually is caused as a result of severe underlying medical conditions like circulatory, cardiac, or respiratory failure, leading to a rate of in-hospital mortality of >50%.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: January 16, 2019

This article does not provide medical advice. See disclaimer

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