34. The Liver in Circulatory Failure

  1. Eugene R. Schiff MD, MACP, FRCP4,
  2. Willis C. Maddrey MD, MACP, FRCP5 and
  3. Michael F. Sorrell MD, FACP6
  1. Santiago J. Munoz MD, FACP, FACG1,
  2. Jonathan M. Fenkel MD2 and
  3. Kiley Kolb DO3

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch34

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Munoz, S. J., Fenkel, J. M. and Kolb, K. (2011) The Liver in Circulatory Failure, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch34

Editor Information

  1. 4

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 5

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 6

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. 1

    Clinical Hepatology, Temple University School of Medicine, Philadelphia, PA, USA

  2. 2

    Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA

  3. 3

    Department of Medicine, Temple University Hospital and School of Medicine, Philadelphia, PA, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509



  • Ischemia;
  • necrosis;
  • hypotension;
  • shock;
  • infarction;
  • hepatitis;
  • congestion;
  • hypoxia;
  • heat shock;
  • cholangiopathy;
  • liver injury


The unique dual blood supply to the liver represents a remarkable defense against ischemic injury caused by circulatory failure. However, episodes of severe arterial hypotension or congestive heart failure may overcome this resistance and induce the development of acute hepatic ischemic injury or congestive hepatopathy, respectively. More severe forms of ischemic injury may lead to hepatic infarction. In patients with underlying cirrhosis, arterial hypotension may result in decompensation and precipitate acute-on-chronic liver failure. The biliary ductal system is especially susceptible to ischemia due to its exclusive perfusion by hepatic artery branches. Other disorders of the circulatory system causing obstruction to the liver venous outflow or diminished hepatic perfusion include the Budd–Chiari syndrome, sinusoidal obstruction syndrome, and hepatic consequences of the heat shock syndrome.