(See also Overview of Vascular Disorders of the Liver.)
Causes are most often systemic:
Focal lesions of the hepatic vasculature are less common causes. Ischemic hepatitis may develop when hepatic artery thrombosis occurs during liver transplantation or when thrombosis of the portal vein and hepatic artery develops in a patient with sickle cell crisis (thus compromising the dual blood supply to the liver). Centrizonal necrosis develops without liver inflammation (ie, not true hepatitis).
Ischemic hepatitis is suspected in patients who have risk factors and laboratory abnormalities:
Serum aminotransferase increases dramatically (eg, to 1000 to 3000 IU/L).
Lactic dehydrogenase (LDH) increases within hours of ischemia (unlike acute viral hepatitis).
Serum bilirubin increases modestly, only to ≤ 4 times its normal level.
Prothrombin time/international normalized ratio (PT/INR) increases.
Treatment is directed at the cause, aiming to restore hepatic perfusion, particularly by improving cardiac output and reversing any hemodynamic instability.