Merck Manual

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Ischemic Hepatitis

(Acute Hepatic Infarction; Hypoxic Hepatitis; Shock Liver)


Whitney Jackson

, MD, University of Colorado School of Medicine

Last full review/revision Jan 2022| Content last modified Jan 2022
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Ischemic hepatitis is diffuse liver damage due to an inadequate blood or oxygen supply.

Etiology of Ischemic Hepatitis

Causes are most often systemic:

Symptoms and Signs of Ischemic Hepatitis

Symptoms may include nausea, vomiting, and tender hepatomegaly.

Diagnosis of Ischemic Hepatitis

  • Clinical evaluation and liver tests

  • Doppler ultrasonography, MRI, or arteriography

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 of Ischemic Hepatitis

  • Hepatic reperfusion

Treatment is directed at the cause, aiming to restore hepatic perfusion, particularly by improving cardiac output and reversing any hemodynamic instability.

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