EDITOR'S QUIZ: GI SNAPSHOT
EDITOR’S QUIZ: GI SNAPSHOT
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From question on page 1190
The echocardiogram demonstrates a pericardial effusion with cardiac tamponade. This resulted in ischaemic hepatitis (IH) and acute liver failure (ALF). An emergency pericardiocentesis was performed, and circulatory function immediately improved. Liver and renal function normalised over the next 15 days (fig 1
).
Figure 1 Graphs showing the biochemical changes in the reported case. The acute rise and fall in alanine aminotransferase (ALT) and international normalised ratio (INR), with a delayed rise in bilirubin, are characteristic of ischaemic hepatitis. The arrows denote when pericardiocentesis was performed.
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IH is an uncommon but well described cause of ALF. In this case, ischaemic liver injury occurred because of a combination of factors: right heart failure (acute hepatic congestion) and decreased hepatic arterial perfusion, secondary to hypotension from cardiac tamponade.
IH occurs in the setting of the following predisposing factors: reduced hepatic arterial flow states, passive liver congestion and arterial hypoxaemia.
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Gut 2007 56: 1190.[Extract] [Full Text] [PDF]
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