hepatic infarction

Hepatic infarction, also known as liver infarction, is a rare condition where areas of coagulative necrosis occur in the liver due to local ischemia [1]. This means that there is a lack of blood flow and oxygen supply to certain parts of the liver, leading to cell death.

The severity and characteristics of hepatic injury depend on the blood vessels involved and the degree to which injury is related to passive congestion or diminished perfusion [1]. Hepatic infarctions appear as hypoechoic nonvascular regions on conventional and Doppler sonography [2].

Hepatic infarction can be caused by thrombosis or ligation of the main hepatic artery between the origin of the right gastric artery and the hilum of the liver [3]. It is a rare event given the liver's dual blood supply from the hepatic artery and portal vein, but reported cases typically involve occlusion of a single intrahepatic branch of the hepatic artery [13].

Symptoms of hepatic infarction may include transient rise in ALT with leukocytosis, symptoms similar to cholangitis, but not all need to be present [13]. The presence of extensive collaterals is another contributing factor to the rarity of HI [12].

Hepatic infarction can also occur due to focal lesions of the hepatic vasculature or ischemic hepatitis when hepatic artery thrombosis occurs during liver transplantation or when thrombosis of the portal vein and hepatic artery develops in a patient with sickle cell crisis [14].

Hepatic infarction, also known as liver infarction, is a serious medical condition that occurs when there is a lack of blood flow to the liver, resulting in tissue death. The signs and symptoms of hepatic infarction can vary depending on the severity and location of the infarct, but common symptoms include:

• Abdominal pain: This is often the most prominent symptom, and it can range from mild to severe [3].
• Nausea and vomiting: These symptoms are often associated with abdominal pain and can be a sign that the liver is not functioning properly [1].
• Fever: A fever can occur as the body's response to tissue damage and inflammation [6].
• Right upper quadrant pain: This type of pain is often felt in the area where the liver is located, just below the right ribs [11].
• Jaundice: In some cases, hepatic infarction can cause jaundice, which is a yellowing of the skin and eyes due to a buildup of bilirubin [10].

It's worth noting that these symptoms can be similar to those experienced in other liver conditions, such as hepatitis or cirrhosis. Therefore, a proper diagnosis by a medical professional is essential for accurate treatment.

References:

[1] Context result 1 [3] Context result 3 [6] Context result 6 [10] Context result 10 [11] Context result 11

Hepatic infarction, also known as liver infarction, can be diagnosed through a combination of imaging studies, serum studies, and possible liver biopsy.

Imaging Studies

• Imaging studies such as CT scans are often used to diagnose liver infarction. According to [6], CT scans can suggest the diagnosis in patients without liver tumors.
• MRI and ultrasound may also be used to confirm the diagnosis and rule out other conditions such as liver abscess or cholangiocarcinoma.

Serum Studies

• Serum studies, including blood tests to check liver function (AST and ALT), are commonly used to screen for liver disorders. Elevated levels of these enzymes can indicate liver damage.
• Other serum studies, such as bilirubin and alkaline phosphatase, may also be ordered to assess liver function.

Liver Biopsy

• A liver biopsy may be necessary in some cases to confirm the diagnosis of hepatic infarction. According to [7], a liver biopsy can help distinguish liver infarction from other diseases such as liver abscess or cholangiocarcinoma.
• Imaging studies, serum studies, and clinical evaluation are often used together to make an accurate diagnosis.

Other Tests

• Blood tests may also be ordered to check for signs of organ hypoperfusion, such as acute renal injury and elevated serum creatinine. According to [15], these tests can indicate the severity of liver damage.
• Other tests, such as a CT scan or MRI, may be used to evaluate the extent of liver damage.

It's worth noting that the precise diagnosis of liver infarction always requires imaging studies, serum studies, and possible liver biopsy, according to [5].

Treatment Options for Hepatic Infarction

Hepatic infarction, also known as ischemic hepatitis or focal ischemic injury of the liver, is a rare but serious condition that requires prompt medical attention. While there are no specific management strategies that have been effective in treating hepatic infarction, anticoagulation therapy has been suggested to be beneficial even in the absence of clear-cut thrombosis [2][3].

Anticoagulation Therapy

One prospective study showed a portal vein recanalization rate of 39% with anticoagulation therapy [6]. Novel oral anticoagulants have also been effective in treating hepatic infarction, although more research is needed to confirm their efficacy.

Conservative Management

In some cases, conservative management may be employed, particularly if the underlying condition can be treated appropriately. This approach involves monitoring the patient's symptoms and liver function, and adjusting treatment as necessary [4].

Restoring Hepatic Perfusion

Treatment for hepatic infarction is directed at restoring hepatic perfusion, which can be achieved by improving cardiac output and reversing any hemodynamic instability [15]. If perfusion is restored, aminotransferase levels typically decrease over 1 to 2 weeks, and in most cases, liver function is fully restored.

Other Treatment Options

In some cases, treatment may involve addressing the underlying cause of hepatic infarction, such as treating a peptic ulcer or abdominal pain secondary to active periarteritis nodosa [7]. In rare instances, hepatic reperfusion may be necessary to restore blood flow to the affected area.

References:

[2] Suggests that anticoagulation can be administered to treat hepatic infarctions even in the absence of clear-cut thrombosis. [3] Confirms that anticoagulation therapy has been suggested as a treatment option for hepatic infarction. [6] Reports a portal vein recanalization rate of 39% with anticoagulation therapy. [15] States that treatment is directed at restoring hepatic perfusion, particularly by improving cardiac output and reversing any hemodynamic instability.

Differential Diagnoses of Hepatic Infarction

Hepatic infarction, also known as liver infarction, is a rare condition where a part of the liver tissue dies due to lack of blood supply. The differential diagnoses for hepatic infarction include various conditions that can present with similar symptoms and imaging findings.

Listed below are some of the differential diagnoses:

• Intrahepatic abscess: A collection of pus in the liver, which can cause fever, abdominal pain, and jaundice.
• Acute fatty liver of pregnancy: A rare condition that occurs during pregnancy, characterized by liver dysfunction and fatty infiltration.
• Thrombotic thrombocytopenic purpura (TTP): A blood disorder that causes clotting in small blood vessels, leading to organ damage and bleeding.
• Hemolytic uremic syndrome (HUS): A condition characterized by hemolysis, thrombocytopenia, and acute kidney injury.
• Ruptured hepatic adenoma: A rare tumor of the liver that can rupture and cause internal bleeding.
• Hepatocellular carcinoma: A type of liver cancer that can present with similar symptoms to hepatic infarction.
• Hemangioma: A benign tumor composed of blood vessels, which can be mistaken for a liver infarct.

These conditions should be considered in the differential diagnosis when the following criteria are present:

• The patient usually has periarteritis (inflammation of the arteries) [4].
• Imaging studies show a lesion or mass in the liver that is consistent with an infarct.
• Laboratory tests reveal elevated liver enzymes and bilirubin levels.

Early recognition and treatment of hepatic infarction are crucial to prevent complications and improve outcomes.

References:

[1] by R Carroll · 1963 · Cited by 69 [2] by DD Adler · 1984 · Cited by 80 [3] by Q Guo · 2018 · Cited by 21 [4] by R Carroll · 1963 · Cited by 69