ABSTRACT
Elevated serum transaminase levels can have many different etiologies, especially
in the pregnant patient. Hypoxic hepatitis is a distinct syndrome caused by decreased
hepatic blood flow that presents with a marked, but transient, increase in liver enzymes.
A 28-year-old woman, gravida 3, para 2 with history of gastric bypass, presented in
the second trimester with bright red blood per rectum, syncope, and epigastric pain.
Laboratory studies were significant for anemia, elevated liver enzymes, and low platelets,
raising concern for hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome)
and the need for emergent delivery. Complete evaluation included an upper endoscopy,
which revealed a bleeding jejunal ulcer that was subsequently cauterized. Shortly
after cauterization, the patient's laboratory values normalized and her pain resolved.
Diagnosis of hypoxic hepatitis was made after exclusion of other liver-toxic entities,
thus preventing delivery of a preterm infant. Hypoxic hepatitis may masquerade as
other clinical syndromes, especially in the pregnant patient. Meticulous physical
examination and assessment of laboratory values is essential for making a proper diagnosis
and guiding management.
KEYWORDS
Hypoxic hepatitis - gastric bypass - HELLP - transaminase
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Dr. Nicole E Kummer
Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University
333 Cedar St. P.O. Box 208063, New Haven, CT 06520
Email: nicole.kummer@yale.edu
