Harun AKAR, Taşkın ŞENTÜRK, Vahit YÜKSELEN, Çiğdem Özbaşlı LEYİ, Nil ÇULHACI, Gürhan KADIKÖYLÜ, İrfan YAVAŞOĞLU

HİPOTANSİYONUN YOL AÇTIĞI BİR İSKEMİK HEPATİT OLGUSU

İskemik hepatit, karaciğerde dolaşım yetmezliği sonucu, 24 saat içinde serum transaminaz ve laktik dehidrogenaz seviyelerinin normale göre 75-100 katı kadar yükselip, 7-10 gün içinde tekrar normale dönmesi ile karakterize klinik bir tablodur. İskemik hepatite hipotansiyon, hipoksi veya her ikisi birlikte öncülük edebilir ve bu olgularda hipotansiyonun en sık nedeni kardiyovasküler hastalıklardır. Histopatolojik olarak karaciğer biyopsisinde sentrilobüler nekrozun görülmesi tipiktir. Bu makalede miyokard infaktüsü sonrası gelişen hipotansiyon sonucunda karaciğer enzimlerinde ani ve belirgin yükselme ve sonrasında hızlı düşme ile ortaya çıkan iskemik hepatitli bir olguyu sunduk ve hastalığın özelliklerini tartıştık

Anahtar Kelimeler:

İskemik hepatit, hipotansiyon

A Case of Hypotension Induced Ischemic Hepatitis

Ischemic hepatitis is a disease clinically characterized by a sudden rise in serum transaminases and lactic dehydrogenase levels to 75- to 100-fold normal levels, followed by resolution to near normal levels within 7 to 10 days as a result of an acute circulatory failure due to cardiovascular disease in most of the reported cases. Such impairment of liver function tests is due to haemodynamic hepatocyte injury that results from failure of hepatic perfusion. Liver biopsy shows focal centrilobular necrosis. Ischemic hepatitis should be anticipated in all patients with a recent history of systemic hypotension. In this paper we describe a case of ischemic hepatitis, in which an acute derangement of liver function tests occurred as a consequence of myocardial infarction and discuss features of this disease.

Keywords:

Ischemic hepatitis, hypotension,

PDF

___

1. Fuchs S, Bogomolski-Yahalom V, Paltiel O, Ackerman Z. Ischemic hepatitis: clinical and laboratory observations of 34 patients. J Clin Gastroenterology 1998; 26:183-6.
2. Lefkovitch JH, Mendez L. Morphologic features of hepatic injury in cardiac disease and shock. J Hepatol 1986; 2 : 313-327.
3. Gitlin NG, Serio KM. Ishemic hepatitis: Widening horizons.Am J Gastroenterol 1992; 7 : 831.
4. Johnson RD, O'Connor ML, Kerr RM. Extreme serum elevations of aspartate aminotransferase. Am J Gastroenterol 1995; 90 : 1244.
5. Seeto RK, Fenn B, Rockey DC. Ischemic hepatitis: clinical presentation and pathogenesis. Am J Med 2000; 109: 109-13.
6. Henrion J, Luwaert R, Colin L, Shimtz A, Scharipa M, Heller FR. Hypoxic hepatitis. A propective, clinical and hemodynamic study of 45 episodes. Gastroentrol Clin Biol 1990; 14 : 836-841.
7. Dunn GD, Hayes P, Breen KJ, Schenker S. The liver in conjestive heart failure. A review Am J Med Sci 1973 ; 265 : 174-189.
8. Schafer DF, Sorrell MF. Vascular disease of the liver, ischemic hepatitis. In: Feldman M, Scharschmidt BF, Sleisenger MH (eds). Sleisenger&Fordtran's Gastrointestinal and Liver Disease, 6 edition, WB Saunders Company, Philadelphia, 1998 ;p:1194.
9. Naschitz JE , Slobodin G, Lewis R J, Zuckerman E, Yeshurun D. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J. 2000: 140(1) : 111-20.
10. Potter JM, Hickman PE. Cardiodepressant drugs and the high mortality rate associated with ischemic hepatitis Critical Care Medicine 1992; 20: 474-478.
11. Mathurin P, Durand F, Ganne N, Mollo JL, Lebrec D, Degott C, Erlinger S, BenhamouJP, Bernuau J. Ischemic hepatitis due to obstructive sleep apnea Gastroenterology 1995; 109 : 1682-1684.
12. Holland SM, Gallin JI. Disorders of granulocytes and monocytes. In: FauciAS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL. Harrison's Principles of internal medicine, 14th edition, NewYork, McGraw-Hill, 1998; p: 355.
13. Cassidy WM, Reynolds TB. Serum lactic dehydrogenase in the differential diagnosis of acute hepatocellular injury. J Clin Gastroenterol 1994; 19: 118-21.