Laboratory results indicated the following: mild hepatocellular
dysfunction; aspartate aminotransferase, 158 U/L (normal, 7 to 40 U/L);
alanine aminotransferase, 51 U/L (normal, 0 to 30 U/L); γ-glutamyl
transpeptidase, 69 U/L (normal, 0 to 35 U/L); alkaline phosphatase, 321
U/L (normal, 20 to 120 U/L); bilirubin, 1.1 mg/dL (normal, 0 to 1.5
mg/dL); lactate dehydrogenase, 236 U/L (normal, 100 to 220 U/L); and an
international normalized ratio of 1.17 (normal, 0.81 to 1.21) and
partial prothrombin time of 32 s (normal, 21.5 to 32.5 s).
A liver biopsy showed chronic active hepatitis, early cirrhosis, but no
rejection. Abdominal ultrasound revealed ascites and no vascular flow
in the hepatic arteries. Celiac and superior mesenteric angiogram
revealed patent portal and hepatic veins, but complete occlusion of the
hepatic artery with extensive collateralization from the inferior
phrenic, right colic, and ileocolic arteries. CT of the abdomen showed
no focal hepatic lesions and no biliary dilatation, but did show
extensive gastroepiploic, gastroesophageal, and peripancreatic varices.