Ischemic Hepatitis

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  • Ischemic hepatitis (shock liver) is diffuse hepatic injury resulting from acute hypoperfusion. It accounts for up to 10% of patients admitted to an intensive care unit.
    • Can occur in the absence of shock
    • Differential diagnoses include toxic hepatitis (such as caused by acetaminophen) and acute viral hepatitis.
      • The diffuse nature of the injury distinguishes it from hepatic infarction, which is focal injury.
  • Don’t document “elevated LFTs” or “acute liver injury.”
  • Do document “ischemic hepatitis.”
    • If either ischemic hepatitis or shock liver are documented, the code for acute and subacute hepatic failure without coma will be reported
      • “Shock Liver” may be used interchangeably with “ischemic hepatitis.”

Clinical Example:

  • A 65-year-old patient underwent a left THA. Intraoperatively, the patient had a transient episode of hypotension with a systolic blood pressure in the 70’s. The CMP the day after surgery revealed an initial AST/ALT of 304/80 and 490/141 the following day. The elevated transaminases were believed to be secondary to poor liver perfusion secondary to transient hypotension during surgery.
  • Adding the diagnosis of ischemic hepatitis (shock liver) resulted in a major complicating condition (MCC).

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