Infarction of the liver

Gastroenterology

Clinicals - History

Fact Explanation
Asymptomatic Some patients with hepatic infarction remain asymptomatic. Asymptomatic
Some patients with hepatic infarction remain asymptomatic.
Abdominal pain Patients present with pain in the right hypochondrium due to renal ischemia. Abdominal pain
Patients present with pain in the right hypochondrium due to renal ischemia.
Jaundice Some patients can present with jaundice due to liver failure. Jaundice
Some patients can present with jaundice due to liver failure.
History of transjugular intrahepatic portosystemic shunt (TIPS) placement Patients with cirrhosis can develop hepatic infarction after placement of a TIPS. History of transjugular intrahepatic portosystemic shunt (TIPS) placement
Patients with cirrhosis can develop hepatic infarction after placement of a TIPS.
History of liver biopsy Development of hepatic artery pseudoaneurysms (HAP) is a complication of liver biopsy. Patients with HAP can be asymptomatic or present with abdominal pain, hematemesis, anemia, hypovolemia, massive gastrointestinal bleeding and jaundice after the liver biopsy. History of liver biopsy
Development of hepatic artery pseudoaneurysms (HAP) is a complication of liver biopsy. Patients with HAP can be asymptomatic or present with abdominal pain, hematemesis, anemia, hypovolemia, massive gastrointestinal bleeding and jaundice after the liver biopsy.
Treatment of hepatocellular carcinoma (HCC) Among the options of treatment for HCC percutaneous ethanol injection and percutaneous arterial embolization carries a risk of hepatic infarction. Although rare, RFA also carries a small risk of hepatic infarction. Treatment of hepatocellular carcinoma (HCC)
Among the options of treatment for HCC percutaneous ethanol injection and percutaneous arterial embolization carries a risk of hepatic infarction. Although rare, RFA also carries a small risk of hepatic infarction.
History of laparoscopic abdominal surgery Patients who have underwent laparoscopic abdominal surgery, can develop hepatic necrosis as a complication of the procedure. Anesthetic agents, accidental ligation or cutting of the vessels can be the causative factors. History of laparoscopic abdominal surgery
Patients who have underwent laparoscopic abdominal surgery, can develop hepatic necrosis as a complication of the procedure. Anesthetic agents, accidental ligation or cutting of the vessels can be the causative factors.
History of pre-eclampsia Pre-eclampsia is a complication of pregnancy induced hypertension (PIH). PIH occurs in the second trimester of the pregnancy. Females present with high blood pressure, generalized edema and in severe cases seizures can develop. History of pre-eclampsia
Pre-eclampsia is a complication of pregnancy induced hypertension (PIH). PIH occurs in the second trimester of the pregnancy. Females present with high blood pressure, generalized edema and in severe cases seizures can develop.
History of antiphospholipid syndrome (APS) Patients with APS are at risk of hepatic infarction due to thrombosis of vessels. History of antiphospholipid syndrome (APS)
Patients with APS are at risk of hepatic infarction due to thrombosis of vessels.

Clinicals - Examination

Fact Explanation
Jaundice Patients can develop jaundice with liver failure. Jaundice
Patients can develop jaundice with liver failure.
Edema Generalized pitting edema is another manifestation of severe liver failure. Edema
Generalized pitting edema is another manifestation of severe liver failure.

Investigations - Diagnosis

Fact Explanation
Hepatic transaminases Death of hepatocytes causes elevated transaminases. Hepatic transaminases
Death of hepatocytes causes elevated transaminases.
Liver function test Hepatic infarction results in liver failure. Elevated bilirubin and prolonged PT/INR can be observed. Liver function test
Hepatic infarction results in liver failure. Elevated bilirubin and prolonged PT/INR can be observed.
Ultrasound scan Ultrasound scan of the liver shows areas of decreased echogenicity. When combined with Doppler scans ultrasound scan is helpful in in detecting obliterated vessel. Ultrasound scan
Ultrasound scan of the liver shows areas of decreased echogenicity. When combined with Doppler scans ultrasound scan is helpful in in detecting obliterated vessel.
CT scan CT scan shows the wedge-shaped, rounded or irregular lesions of hepatic infarction as hypodense areas. In the presence of secondary infection gas can be seen around the area of infarction. CT scan
CT scan shows the wedge-shaped, rounded or irregular lesions of hepatic infarction as hypodense areas. In the presence of secondary infection gas can be seen around the area of infarction.
Angiogram Angiogram can localize the obliterated vessel which is responsible for the development of hepatic infarction. Angiogram
Angiogram can localize the obliterated vessel which is responsible for the development of hepatic infarction.
Nuclear imaging Ischemic and necrosed areas of the liver paranchyma can be illustrated with the use of nuclear imaging. Nuclear imaging
Ischemic and necrosed areas of the liver paranchyma can be illustrated with the use of nuclear imaging.

Investigations - Management

Fact Explanation
Liver function test Progression of the disease and recovery should be monitored with liver function tests (serum bilirubin, PT/INR) and hepatic transaminases. Liver function test
Progression of the disease and recovery should be monitored with liver function tests (serum bilirubin, PT/INR) and hepatic transaminases.
Renal function test Renal failure can arise as a complication of liver failure (hepato-renal syndrome). Patients have elevated serum creatinine and abnormal electrolyte profile. Renal function test
Renal failure can arise as a complication of liver failure (hepato-renal syndrome). Patients have elevated serum creatinine and abnormal electrolyte profile.

Management - Supportive

Fact Explanation
Management of bile leakage If bile leaking is present, it can be treated with either percutaneous drainage or with surgery. Management of bile leakage
If bile leaking is present, it can be treated with either percutaneous drainage or with surgery.
Management of hepatic abscess Some patients with hepatic infarction can develop secondary infection and abscess formation. Percutaneous drainage of the abscess can be done. Open surgical drainage should be done if percutaneous drainage fails. Management of hepatic abscess
Some patients with hepatic infarction can develop secondary infection and abscess formation. Percutaneous drainage of the abscess can be done. Open surgical drainage should be done if percutaneous drainage fails.

Management - Specific

Fact Explanation
Conservative management Most of the uncomplicated hepatic infarctions can be managed conservatively. Conservative management
Most of the uncomplicated hepatic infarctions can be managed conservatively.
Surgery Surgical resection of the necrosed liver paranchyma is indicated if conservative management fails or if the patient develops complications (bile leakage, abscess formation). Surgery
Surgical resection of the necrosed liver paranchyma is indicated if conservative management fails or if the patient develops complications (bile leakage, abscess formation).
Management of hepatic artery pseudoaneurysm Hepatic artery pseudoaneurysm is treated with endovascular embolization or open surgical repair. Management of hepatic artery pseudoaneurysm
Hepatic artery pseudoaneurysm is treated with endovascular embolization or open surgical repair.

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