Background: Ischemic hepatitis (commonly referred to as shock liver and hypoxic hepatitis) is an uncommon clinical condition associated with massive but transient elevation of liver enzymes up to more than 20 times the standard limit; without evidence of other causes of acute hepatitis such as viral, alcoholic, metabolic, and toxin-induced hepatitis. Clinically, it presents as an acute liver failure caused by decreased hepatic perfusion and oxygen delivery. It is often encountered in critically ill patients in intensive care units and can rarely be triggered by pericardial tamponade. Case presenta- tion: On  hemodialysis,  a  33-year-old  end-stage renal  disease male  patient  with  hypertension and cardiomegaly presented with right upper quadrant pain. Examination revealed elevated jugu- lar venous pressure, displaced apical beat, tender right upper quadrant and epigastric areas, and enlarged  liver  with  a  round  border  and  soft  surface.  Electrocardiography  revealed  P  mitral  and electrical alternans but no ischemic changes. Chest radiography showed an increased cardiothoracic ratio and flask-shaped heart. Extensive laboratory investigations showed elevated levels of aspar- tate aminotransferase (5000 U/L) and alanine aminotransferase (7000 U/L). Ultrasound showed passive congestion of the liver. Pericardial effusion was confirmed by echocardiography, and the diagnosis  of  cardiac  tamponade  was  established.  Pericardiocentesis  was  done,  and  1200  ml  of bloody  fluid  was  aspirated.  After  pericardiocentesis,  the  patient  demonstrated  dramatic  improve- ment. Conclusions: Ischemic hepatitis is an uncommon entity associated with a significant mortality rate,  mainly  when  it  develops  on  top  of  decreased  cardiac  output.  Therefore,  physicians  must  be familiar with the broad differential diagnosis for liver disease signs and symptoms and should always consider the possibility of ischemic hepatitis in such cases.
 

Title

Palestinian Medical and Pharmaceutical Journal (PMPJ)

Publisher

An-Najah National University

Publisher Country

Palestine

Indexing

Scopus

Impact Factor

None

Publication Type

Both (Printed and Online)

Volume

8

Year

2023

Pages

6