Overview
Hepatic infarction refers to the death of liver tissue due to obstruction of blood supply, often secondary to thrombotic or embolic events. It is a rare but severe condition characterized by significant morbidity and potential mortality 12.Diagnosis
Clinical Presentation: Fever, altered mental status, jaundice, ascites, ileus, and renal failure 2.
Biochemical Markers: Elevated SGOT, SGPT, alkaline phosphatase, total bilirubin, and decreased thromboplastin time 2.
Imaging:
- Scintigraphy: Tc-99m sulfur colloid imaging can detect infarcted areas 1.
- Computed Tomography (CT): Useful for in vivo diagnosis, showing characteristic patterns of infarction 2.
Angiography: Reveals thrombotic occlusion or vascular abnormalities, such as fibromuscular hyperplasia 2.
Histopathology: Confirmed via laparoscopy and biopsy 2.Management
Reperfusion Therapy: Early restoration of blood flow, potentially through thrombolysis or surgical intervention 2.
Supportive Care: Management of complications including renal failure, coagulopathy, and hepatic encephalopathy 2.
Anticoagulation: Post-event anticoagulation to prevent recurrence, specific dosing not detailed 2.
Monitoring: Close monitoring of liver function tests and clinical status 2.Special Populations
Pregnancy: Postpartum hepatic artery thrombosis leading to infarction has been reported, highlighting the need for vigilant monitoring 2.
Comorbidities: Pre-existing vascular conditions, such as fibromuscular hyperplasia, may predispose to hepatic infarction 2.Key Recommendations
Utilize CT and angiography for definitive diagnosis of hepatic infarction (Evidence: Moderate 2).
Initiate urgent reperfusion strategies and supportive care to manage complications (Evidence: Moderate 2).
Consider anticoagulation post-event to prevent recurrence, tailored to patient-specific risk factors (Evidence: Expert opinion 2).References
1 Burke TS, Tatum JL. Hepatic infarction detected on Tc-99m sulfur colloid imaging. Clinical nuclear medicine 1990. link
2 Dammann HG, Hagemann J, Runge M, Klöppel G. In vivo diagnosis of massive hepatic infarction by computed tomography. Digestive diseases and sciences 1982. link