Definition

Hepatic ischemia is a condition in which the liver does not get enough blood or oxygen. This causes injury to liver cells.

Alternative Names

Ischemic hepatitis; Shock liver

Causes

Low blood pressure from any condition can lead to hepatic ischemia. Such conditions may include:

• Abnormal heart rhythms
• Dehydration
• Heart failure
• Infection, especially sepsis
• Severe bleeding

Other causes may include:

• Blood clots in the main artery to the liver (hepatic artery) after a liver transplant
• Inflammation of blood vessels, leading to reduced blood flow (vasculitis)
• Burns
• Heat stroke
• Having a sickle cell crisis

Symptoms

The person may have an altered mental status due to reduced blood flow to the brain. Other symptoms may include:

• Loss of appetite
• Feeling of general discomfort
• Discomfort in the right upper quadrant of your abdomen
• Jaundice

Damage to the liver cells most often does not cause symptoms until it affects liver function.

Blood clots in the liver's main artery may cause abdominal pain.

Exams and Tests

The following tests will be done:

• Blood tests to check liver function (AST and ALT). These readings can be very high (in the thousands) with ischemia.
• Doppler ultrasound of the blood vessels of the liver.

Treatment

Treatment depends on the cause. Low blood pressure and blood clots must be treated right away.

Outlook (Prognosis)

People generally recover if the illness causing hepatic ischemia can be treated. Death from liver failure due to hepatic ischemia is very rare.

Possible Complications

Liver failure is a rare, but fatal complication.

When to Contact a Medical Professional

Contact your health care provider right away if you have persistent weakness or symptoms of shock or dehydration.

Prevention

Quickly treating the causes of low blood pressure may prevent hepatic ischemia.

References

Korenblat KM. Approach to the patient with jaundice or abnormal liver tests. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 133.

Nery FG, Valla DC. Vascular diseases of the liver. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 85.