Ischemic hepatitis as a cause of reversible ascites: Case report

Öz

Ischemic hepatitis is a clinical entity which occurs due to hypotensive episodes and/or poor liver tissue perfusion and is characterized by marked transaminase elevations. Clinical presentation is usually in an acute and non-specific manner, while ascites is a rare finding. A 70-year-old male with congestive heart failure was admitted to the hospital with the complaints of fatigue, dyspnea on exertion, nausea and abdominal swelling. The investigations after the findings of hypertransaminasemia and ascites disclosed the diagnosis of ischemic hepatitis due to decompensated heart failure, which was a consequence of acute erosive gastritis-induced anemia. The clinical and laboratory features resolved promptly with conservative measures. Etiopathogenesis and clinical presentation of ischemic hepatitis are discussed with respect to the current case. In clinical practice, ischemic hepatitis should be kept in mind as a cause of reversible ascites.

Anahtar Kelimeler

• Ischemic hepatitis, reversible ascites, anemia

Reversibl asite neden olan iskemik hepatit: Olgu sunumu

Öz

İskemik hepatit, dolaşım bozukluğuna bağlı hipotansif episodlar ve/veya primer karaciğer dokusu kanlanmasının azalmasına bağlı olarak gelişen klinik bir tablo olup, ciddi düzeyde hipertransaminazemi ile karekterizedir. Klinik prezentasyon genellikle non-spesifik ve akut seyirli olup, asit gelişimi nadirdir. 70 yaşında konjestif kalp yetmezliği tanısı olan erkek hasta halsizlik, efor dispnesi, bulantı ve karında şişkinlik yakınmaları ile başvurdu. Hipertransaminazemi ve asit saptanması üzerine yapılan incelemelerde, akut eroziv gastrit sonrası gelişen anemiye bağlı olarak, varolan kalp yetmezliği tablosunun dekompanse olduğu ve sonucunda iskemik hepatit geliştiği anlaşıldı. Konservatif tedavi ile klinik tablo ve laboratuvar bulguları düzeldi. Bu olgu dolayısıyla, iskemik hepatit etyopatogenezi ve klinik prezentasyonu tartışılmıştır. Klinik pratikte iskemik hepatitin, reverzibl asit oluşumuna yol açan nedenlerden biri olduğu unutulmamalıdır.

Anahtar Kelimeler

• İskemik hepatit, reversibl asit, anemi

Kaynakça

1. Schafer DF, Sorrel MF. Vascular disease of the liver. Gastrointes- tinal and Liver Disease. Eds Feldman M, Fridman LS, Sleisenger MH, 7thed. WB Saunders Co, Philadelphia 2002; 70: 1364-70.
2. Castiella A, Cansio M, Garcia-Bengoechea M. Ischemic hepatitis secondary to the spontaneous rupture of a hepatocelluler carcinoma in a patient with cirrhosis. Liver 1996; 16: 147-50.
3. Hickmann PE, Potter JM. Mortality assosiated with ischemic hepa- titis. Aust NZJ Med 1990; 20: 32-4.
4. Naschitz JE, Yeshurun D, Shahar J. Cardiogenic hepatorenal syndrome. Angiology 1990; 41: 893-900.
5. Sherlock S. The liver in circulatory failure. In: Schiff L, Schiff ER, editors. Disease of the liver. 7th ed. Philadelphia: JB Lippincott; 1993; 1431-37.
6. Whitehead R. Ischaemic enterokolitis: An expression of intravascu- lar coagulation syndrome. Gut 1974; 15: 83-8.
7. Reginald K. Seeto, et al. Ischemic hepatitis: clinical presentation and patogenesis, American Journal Medicine 2000; 109: 2-13.
8. Bynum TE, Boitnott JK, Maddrey WC. Ischemic hepatitis. Dig Dis Sci 1979; 24: 129-35.

9. Hillenbrand P, Parbhoo SP, et al. Significance of intravascular co- agulation and fibrinolysis in acute hepatic failure. Gut 1974; 15: 83-8.
10. Verstrete M, Vermylen J, Collen D. Intravascular coagulation in li- ver disease. Annu Rey Med 1974; 25: 447-55.
11. Clarke WTW. Centrilobuler hepatic hepatic necrosis following car- diac infarction. Am J Pathol 1950: 249-53.
12. Rosenberg PM, Friedman LS. The liver in circulatory failure In: Schiff ER, Sorrell MF, Maddrey WC, et al. Diseases of the liver Vol.2 8th ed. Philadelphia: Lippincott-Raven; 1999: 1221-4.
13. Cellalier G, Bonal J, Bouchiat J, Talard P et al. Foi ischemic aigu. Presse Med 1995; 24: 1418-20.
14. Rawson JS, Achord JL. Shock liver. South Med J 1985; 78: 1421-5.
15. Henrian J. Hypoxic Hepatitis: Clinic and Hemodynamic Study in 142 Consecutive Cases. Medicine 2003; 82: 392-406.
16. Hendry MS. Ischemic hepatitis. Lancet 1985; 1: 1449.
17. Huber MS. Harward TRS, Flynn TC, Albright JL, Seeger JM: Ope- rative mortality rates after elective infrarenal aortic reconstruction. J Vasc Surg 1995; 22: 287-94.
18. Trakada G, Gogos C, Tsiamita M, et al. A case of Ischemic hepati- tis. Laboratory of Sleep, Division of Pulmonology, University Hos- pital of Patras Medical School Sleep Breath 2004; 8: 155-9.
19. Bang NU. Serum glutamic-oxaloasetic transaminase activity as an index of sentrilobüler liver cell necrosis in cardiac and circulatory failure. Acta Med Scand. 1959; 164: 385-9.
20. Gadeholt H. Centrilobular hepatic necrosis in cardiac failure. Acta Med Scand 1996; 176: 525-8.
21. Seeto RK, Fenn B, Rockey DC. Ischemic hepatitis; clinical presen- tation and pathogenesis. Am J Med 2000; 109; 109-13.