ISCHEMIC HEPATITIS IN CIRRHOSIS - CLINICAL-FEATURES AND PROGNOSTIC IMPLICATIONS

To characterize liver dysfunction in patients with cirrhosis after var iceal bleeding, we analyzed 50 cirrhotic patients who had bleeding eso phageal varices with or without shock. Increases in serum total biliru bin levels by 1.5 times were observed within 24 h in 11 of 12 patients with shock who died > 4 days after hemorrhage but in only one of eigh t patients with shock who survived (p < 0.01). Increases in serum aspa rtate aminotransferase and alanine aminotransferase by 2.5 times were observed in six patients in the former group but in none of the latter (p < 0.05). In postmortem livers, hepatocellular degeneration with mi nimal inflammatory cell infiltration was observed. Ischemic hepatitis is frequently noted in cirrhotic patients with ruptured esophageal var ices. Patients with increases in the serum level of total bilirubin an d/or aminotransferases within 24 h from onset of hemorrhage should be carefully treated even if hemorrhage is controlled.