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Ischaemic hepatitis — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsIschaemic hepatitisSCE Acute Medicine

A 69-year-old man presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show ALT 6400 and high LDH after shock. What is the most likely underlying cause/mechanism?

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Correct answer: B — Hepatic hypoperfusion causing ischaemic hepatitis

The key discriminator is that ALT 6400 and high LDH after shock, which makes Hepatic hypoperfusion causing ischaemic hepatitis the single best answer. Tissue hypoperfusion causing lactic acidosis is less appropriate because it does not address the dominant acute risk in the vignette; Portal hypertensive bleeding would fit a different presentation or later stage of care. Impaired free-water excretion from ADH activity and Adrenal steroid deficiency are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG abnormal liver blood tests guideline