Back to Mild to Moderate Aminotransferase Elevation

Introduction

Ischemic injury of the liver occurs in the setting of hypoperfusion states such as hypotension, myocardial injury, severe arrythmia, massive blood loss, and septic shock. Ischemic hepatitis tends to resolve readily once hemodynamic stability is restored.

History

Symptoms or conditions associated with a low perfusion state such as pre-syncopal or syncopal episodes, hypotension, arrhythmias, low ejection fraction within the last day or so.

Physical examination

The associated findings for the suspected causes of shock. For example, fever and rigors in patients with suspected sepsis or melena in suspected GI hemorrhage.

Laboratory investigation

In addition to the relevant investigations based on the clinical presentation, the following liver tests should be ordered:

• Serial aminotransferases (rapid normalization of aminotransferases within a few days is characteristic of ischemic liver injury)
• PT/INR

Patients with ischemic liver injury will often have abnormalities in coagulation. However, as mentioned previously, injury is reversible upon correction of the cause of hypoperfusion.