Hepatic ischemia

Low blood pressure from any condition can lead to hepatic ischemia. Such conditions may include:

• Abnormal heart rhythms
• Dehydration
• Heart failure
• Infection, especially sepsis
• Severe bleeding

Other causes may include:

• Blood clots in the main artery to the liver (hepatic artery) after a liver transplant
• Inflammation of blood vessels, leading to reduced blood flow (vasculitis)
• Burns
• Heat stroke
• Having a sickle cell crisis

The person may have altered mental status due to reduced blood flow to the brain. Other symptoms may include:

• Loss of appetite
• Feeling of general discomfort
• Jaundice

Damage to the liver cells most often does not cause symptoms until it affects liver function.

Blood clots in the liver's main artery may cause abdominal pain.

The following tests will be done:

• Blood tests to check liver function (AST and ALT). These readings can be very high (in the thousands) with ischemia.
• Doppler ultrasound of the blood vessels of the liver.

Treatment depends on the cause. Low blood pressure and blood clots must be treated right away.

People generally recover if the illness causing hepatic ischemia can be treated. Death from liver failure due to hepatic ischemia is very rare.

Liver failure is a rare, but fatal complication.

Contact your health care provider right away if you have persistent weakness or symptoms of shock or dehydration.

Quickly treating the causes of low blood pressure may prevent hepatic ischemia.

Ischemic hepatitis; Shock liver

Korenblat KM, Berk PD. Approach to the patient with jaundice or abnormal liver tests. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 138.

Nery FG, Valla DC. Vascular diseases of the liver. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 85.

Williams MJ, Gordon-Walker TT. Hepatology. In: Penman ID, Ralston SH, Strachan MWJ, Hobson RP, eds. Davidson's Principles and Practice of Medicine. 24th ed. Philadelphia, PA: Elsevier; 2023:chap 24.

Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.