Abstract
Hypoxic hepatitis (HH) is defined as a pathological picture observed in patients with heart failure, respiratory failure, and septic shock in most of the cases. At the histological level, HH is an acute liver injury associated with centrilobular necrosis with varying extent according to the severity of the disease. Its pathogenesis is multifactorial with a main role of hypoxia. Toxic hepatitis, especially acetaminophen, is the main differential diagnosis of HH. In patients with chronic heart failure, congestive hepatopathy is morphologically characterized by sinusoidal dilation and congestion, centrilobular hepatocellular dropout, and fibrosis development that may lead to cirrhosis. While liver biopsy is not required in typical clinical acute cases, accurate assessment of fibrosis in chronic settings is challenging as fibrosis may show significant heterogeneity throughout the liver parenchyma.
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