Ischemia

 Causes nonzonal or “geographic” necrosis



• Drug-induced liver injury

• Chronic passive congestion




Diagnostic Checklist




• Consider in systemically ill patients or those at risk for thrombosis with rapid, extreme rise in aminotransferases

image
Gross Appearance
This gross photograph illustrates a subcapsular hepatic infarct. The infarcted area shows variegated red hemorrhagic areas image admixed with necrosis image .


image
Hepatic Ischemia
This low-power photomicrograph shows zone 3 perivenular hemorrhage and necrosis image in a case of hepatic ischemia. The periportal hepatocytes are well preserved image .

image
Zone 3 Necrosis and Hemorrhage
Well-demarcated areas of hepatocyte necrosis and hemorrhage image are seen in hepatic ischemia. The hemorrhage corresponds to the red areas seen grossly in “nutmeg” liver. Periportal hepatocytes are well preserved image .

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Sharply Delineated Necrosis
This liver biopsy demonstrates a sharp distinction between areas of confluent hepatocyte necrosis image and preserved adjacent hepatocytes image .


TERMINOLOGY


Synonyms




• Ischemic hepatitis or hypoxic hepatitis

• Shock liver

• Hepatic infarction


Definitions




• Liver injury due to reduced blood flow


ETIOLOGY/PATHOGENESIS


Systemic Hypotension &/or Hypoxemia




• Cardiac failure or circulatory shock of any cause


Vascular Obstruction




• Caused by stasis, endothelial injury, and hypercoagulable state
image 1 or more vessels may be involved

• In transplant patients, anastomotic complications lead to vascular thromboses

• In native livers, usually require obstruction of 2 vessels to result in clinically significant ischemia
image Greater collateralization present in native livers, but allografts subject to injury with single vessel obstruction

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Related posts:

  1. Neonatal Hemochromatosis
  2. Hepatoportal Sclerosis
  3. Drug-Related Acute Hepatitis
  4. Biliary Atresia

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Ischemia

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