Ischemic hepatitis

In ischemic hepatitis, which is not rare, there is a marked but transient increase in serum aminotransferase activity to at least 20 times the upper limit of normal, without any other cause for hepatic necrosis. It is generally preceded by an acute cardiac complication, usually pulmonary edema or a tachyarrhythmia, causing decrease in cardiac output, or may follow acute respiratory failure. The typical histological lesion is centrilobular hepatic necrosis. We present 2 cases of ischemic hepatitis due to hypotension following rapid atrial fibrillation, sepsis and acute respiratory failure, highlighting the different etiologies, laboratories results, and the relative benign course, described in the literature. The patients were a woman aged 80 and a man aged 76. Awareness of the place of this disorder in the differential diagnosis of acute hepatitis may save needless, dangerous investigations.