- 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.”
- If either ischemic hepatitis or shock liver are documented, the code for acute and subacute hepatic failure without coma will be reported
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).
Download the complete tip, Ischemic Hepatitis.