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Hepatic Infarction

Infarct of Liver

Hepatic infarction (HI) is necrosis of a segment of liver cells due to ischemia caused mainly by vaso-occlusion. The liver receives a rich blood supply and so, HI is a rare condition.


Presentation

The liver has a dual blood supply, involving the hepatic artery and the portal vein. In addition to that, it has a well-developed collateral system, thus hepatic infarction (HI) is not a frequent ailment [1]. HI occurs when both aforementioned major blood vessels are compromised, leading to ischemia of the liver parenchyma. This, in turn, leads to coagulative necrosis of hepatic tissue. Portal vein thrombosis is often the precipitating factor in HI. There are various causes of HI, including iatrogenic, infective, vascular, post-traumatic and coagulopathic events.

Examples of specific conditions that predispose to HI include those that compromise blood flow to the liver, that is, hypercoagulable states, portal vein thrombosis, hepatic artery occlusion and atherosclerosis. Further, the situations that increase an individual's susceptibility to HI include diabetes, hypovolemia and shock, sepsis and biliary tree disease. Recorded iatrogenic factors include surgical interventions, both open and laparoscopic, liver transplant, and vascular procedures such as trans-catheter arterial embolization and intra-arterial chemoinfusion [1]. Other elements that increase the risk of HI entail vasoconstrictors that act centrally (thus affecting the blood supply of abdominal organs), atherosclerosis and pancreatitis [2] [3] [4].

Patients with HI may be asymptomatic [5]. In the symptomatic individuals, onset is sudden, and common complaints are right upper quadrant pain, fever, jaundice and gastrointestinal upset [6]. Diabetics may not report any pain, due to neuropathy related to hyperglycemia. The white cell count, aspartate transaminase (AST) and alanine transaminase (ALT) are often raised. This medical entity is common in people who underwent a liver transplant.

Hemophilia A
  • . - Biliary: stenosis of the bile duct and biloma (due to heat damage), abscesses (the most common in some series), hemophilia, or even peritoneal bleeding, etc. - Extrahepatic: gastrointestinal tract lesions, vesicular lesions (cholecystitis, more than[elsevier.es]
Severe Abdominal Pain
  • We present a patient who in the third trimester of pregnancy developed severe abdominal pain, fever and transaminases greater than 30 times normal.[ncbi.nlm.nih.gov]
  • Physical findings range from low-grade fever, mild to severe abdominal pain radiating to the back and ileus. Features of severe disease include hematochezia, ascites, metabolic acidosis, and renal or respiratory failure.[saudijobesity.com]
Right Flank Pain
  • Two months later, she experienced right hypochondralgia and right flank pain. Serum transaminase levels were suddenly elevated, and computed tomography scans of the liver showed multiple small nodular lesions.[ncbi.nlm.nih.gov]
Right Flank Pain
  • Two months later, she experienced right hypochondralgia and right flank pain. Serum transaminase levels were suddenly elevated, and computed tomography scans of the liver showed multiple small nodular lesions.[ncbi.nlm.nih.gov]

Workup

Hepatic infarction is best diagnosed via abdominal computerized tomography (CT) scans. Both contrast and non-contrast CTs are used. Non-contrast CT shows an HI as a wedge shaped area of low attenuation. Contrasted CT may highlight impaired perfusion in the infarcted tissue [7]. The site, extent and possible underlying pathology of the HI can be assessed using a CT scan [8]. Abdominal ultrasound examination may reveal hypoechoic lesions and calcifications that suggest infarction. Complications of HI, particularly those of the biliary tree, include abnormal collections of bile, and biliary strictures [9].

Physical examination is important. Positive findings could include jaundice, which may indicate liver failure [6].

Biochemical studies may show elevated aminotransaminase, whereas increased levels of serum bilirubin as well as abnormalities in clotting studies, exemplified by prolonged prothrombin time (PT) and international normalized ratio (INR), are possible findings [5] [6]. Ultrasound scanning and angiography are both useful in locating blockage of a vessel. Nuclear imaging helps in visualizing the areas of necrosis.

Different types of angiography can be used, including CT and magnetic resonance (MR).

Treatment

  • We believe that liver cirrhosis and chronic pancreatitis were the main risk factors for the portal thrombosis, and the treatment for esophageal varices appeared to have triggered the thrombosis.[ncbi.nlm.nih.gov]
  • She was discharged five weeks postpartum with no additional treatment, and is without sequelae six months later.[ncbi.nlm.nih.gov]
  • Magnetic resonance imaging was the imaging modality of choice for diagnosing hepatic infarction, guiding treatment, ensuring the early detection of bleeding, and monitoring liver recovery.[ncbi.nlm.nih.gov]
  • The authors describe a patient who had a secondary liver infarct during anticoagulant treatment for cerebral infarction.[ncbi.nlm.nih.gov]
  • Accurate differential diagnosis of bland PVT from neoplastic PVT is an important step for planning treatment options, but the acute form can be challenging.[ncbi.nlm.nih.gov]

Prognosis

  • The authors evaluated the frequency of hepatic infarction, clinical features, initial and follow-up CT findings, accompanied complications, and prognosis. Potential risk factors were evaluated with multiple logistic regression analysis.[ncbi.nlm.nih.gov]
  • Prognosis The prognosis is mostly related to the severity of the underlying systemic disease. Causes Hepatic artery damage due to.....[gastroenterologybook.com]
  • Classification and staging are discussed at length with reference to treatment planning and correlation to prognosis. Diagnostic tools including X-Ray, CT scan, MRI and bone scan are also described in detail.[books.google.ro]
  • Ischemic hepatitis is generally benign and self-limited, and prognosis is more related to the underlying etiology of shock.[errolozdalga.com]
  • Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol . 1995;172(1 Pt 1):125–9. 25.[aafp.org]

Etiology

  • The etiology, clinical course, and radiologic features of liver infarction are summarized, and the importance of recognizing and treating this form of hypercoagulability is stressed.[ncbi.nlm.nih.gov]
  • Etiologies of infarction included posttransplant complication (15), laparoscopic cholecystectomy complication (2), and traumatic arterial injury (1).[ncbi.nlm.nih.gov]
  • Ischemic hepatitis is generally benign and self-limited, and prognosis is more related to the underlying etiology of shock.[errolozdalga.com]
  • Citation: Endocrinology, Diabetes & Metabolism Case Reports 2017, 1; 10.1530/EDM-16-0144 Discussion The etiology of mesenteric ischemia represents a complex of diseases, including acute arterial mesenteric ischemia, acute venous mesenteric ischemia, non-occlusive[edmcasereports.com]
  • Portomesenteric thrombosis following laparoscopic bariatric surgery: Incidence, patterns of clinical presentation, and etiology in a bariatric patient population. JAMA Surg 2013;148:340-6. 2.[saudijobesity.com]

Epidemiology

  • Glomerular filtration rate (eGFR CKD-EPI ) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study equation [ 13 ].[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • We precisely assessed both hepatic hemodynamics and hepatocellular function using sequential multidetector computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging, which may provide useful information on the pathophysiological[ncbi.nlm.nih.gov]
  • Myeloma: Biology and Pathophysiology, excluding Therapy: Poster III Source Type: research Intensification of therapy for adults with ALL using pediatric regimens with intensive asparagine depletion is feasible.[medworm.com]
  • Despite nearly 200 reports in the last 15 years on the hepato-biliary aspects of the sickling disorders, the frequency and pathophysiology of hepatic lesions remain unclear.[sickle.bwh.harvard.edu]
  • Nitric oxide dysfunction in the pathophysiology of preeclampsia [Review] [204 refs]. Nitric Oxide 2000 ; 4 : 441 –58. 18 Anumba DO, Robson SC, Boys RJ, Ford GA.[academic.oup.com]
  • It typically arises in the third trimester of pregnancy, although it has been reported as early as 13 weeks' gestation. 18 – 20 The pathophysiology of intrahepatic cholestasis of pregnancy remains poorly understood. 19 Pruritus alone occurs in 80 percent[aafp.org]

Prevention

  • Attention should be paid to inadvertent injury of hepatic artery to prevent hepatic infarction. Hepatic infarctions after pancreato-biliary surgery seldom extend to the entire liver and most of them are able to be treated without intervention.[ncbi.nlm.nih.gov]
  • In conclusion, when an operative injury to the hepatic artery is encountered, the hepatoduodenal ligament should not be manipulated any more than necessary to preserve the collaterals, and the gallbladder should be removed to prevent necrotic perforation[ncbi.nlm.nih.gov]
  • However, specific guidelines for the prevention of thrombosis in such patients have not been described.[edmcasereports.com]
  • Milk thistle (aka silymarin) is a dietary supplement traditionally used by herbalists to treat and to prevent damage to the liver. – Best food in NW Wisconsin –Local and Organic options: Helps the liver to regenerate There are many herbs and ingredient[pkpi.eu]
  • Preeclampsia prevention: lessons from the low‐dose aspirin therapy trials [Review] [25 refs]. Am J Obstet Gynecol 2000 ; 183 : 523 –8. 24 Rogers MS, Fung HY, Hung CY.[academic.oup.com]

References

Article

  1. Martinez VA, Garcia RC, Sauri CA, Mayayo AE, Oliver RJ. Hepatic infarction: an unusual complication of nephrotic syndrome in a patient with diabetes mellitus. Postgrad Med J. 1990;66(781):968-970.
  2. Maruyama M, Yamada A, Kuraishi Y, et al. Hepatic infarction complicated with acute pancreatitis precisely diagnosed with gadoxetate disodium-enhanced magnetic resonance imaging. Intern Med. 2014;53(19):2215–2221.
  3. Deng YG, Zhao ZS, Wang M, Su SO, Yao XX. Diabetes mellitus with hepatic infarction: a case report with literature review. World J Gastroenterol. 2006;12(31):5091–5093.
  4. Oh D, Park do H, Cho YW, et al. Hepatic infarction caused by vascular migration of fiducial marker previously under endosonographic guidance to assist radiotherapy. Endoscopy. 2014;46(suppl 1 UCTN):E585–E586.
  5. Bishehsari F, Ting P-S, Green RM. Recurrent gastrointestinal bleeding and hepatic infarction after liver biopsy. World J Gastroenterol. 2014;20(7):1878-1881.
  6. López-Méndez E, Zamora-Valdés D, Díaz-Zamudio M, Fernández-Díaz OF, Ávila L. Liver failure after an uncovered TIPS procedure associated with hepatic infarction. World J Hepatol. 2010;2(4):167-170
  7. Torabi M, Hosseinzadeah K, Federle MP. CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 2008;28(7):1967-1982
  8. Giovine S, Pinto A, Crispano S, Lassandro F, Romano L. Retrospective study of 23 cases of hepatic infarction: CT findings and pathological correlations. Radiol Med. 2006;111(1):11–21.
  9. Cook GJ, Crofton ME. Hepatic artery thrombosis and infarction: Evolution of the ultrasound appearances in liver transplant recipients. Br J Radiol. 1997;70(831):248-251.

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Last updated: 2018-06-22 06:18