Congestive hepatopathy

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Nutmeg liver
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Congestive hepatopathy
Other namesNutmeg liver and Chronic passive congestion of the liver
Trichrome stain.
SpecialtyGastroenterology, hepatology Edit this on Wikidata

Congestive hepatopathy, is

congestive heart failure. The gross pathological appearance of a liver affected by chronic passive congestion is "speckled" like a grated nutmeg kernel; the dark spots represent the dilated and congested hepatic venules and small hepatic veins. The paler areas are unaffected surrounding liver tissue. When severe and longstanding, hepatic congestion can lead to fibrosis; if congestion is due to right heart failure, it is called cardiac cirrhosis.[1]

Signs and symptoms

Signs and symptoms depend largely upon the primary lesions giving rise to the condition. In addition to the heart or lung symptoms, there will be a sense of fullness and tenderness in the right

hypochondriac region. Gastrointestinal catarrh is usually present, and vomiting of blood may occur. There is usually more or less jaundice. Owing to portal obstruction, ascites occurs, followed later by generalised oedema. The stools are light or clay-colored, and the urine is colored by bile. On palpation, the liver is found enlarged and tender, sometimes extending several inches below the costal margin of the ribs.[citation needed
]

Pathophysiology

CT appearance of liver in congestive hepatopathy, sometimes referred to as a nutmeg liver. Due to congestion, contrast does not flow through the liver in a normal manner. Axial and coronal images in the portal venous phase.

Increased pressure in the sublobular branches of the

hepatic veins causes an engorgement of venous blood, and is most frequently due to chronic cardiac lesions, especially those affecting the right heart (e.g., right-sided heart failure), the blood being dammed back in the inferior vena cava and hepatic veins. Central regions of the hepatic lobules are red–brown and stand out against the non-congested, tan-coloured liver. Centrilobular necrosis occurs.[2]

Macroscopically, the liver has a pale and spotty appearance in affected areas, as stasis of the blood causes pericentral

interstitial pneumonia, pleural effusions, and intrathoracic tumors.[citation needed
]

Diagnosis

It is diagnosed with laboratory testing, including liver function tests, and radiology imaging, including ultrasounds.[3][4]

Treatment

Treatment is directed largely to removing the cause, or, where that is impossible, to modifying effects of the heart failure.[5] Thus, therapy aimed at improving right heart function will also improve congestive hepatopathy. True nutmeg liver is usually secondary to left-sided heart failure, causing congestive right heart failure, so treatment options are limited.[citation needed]

Treatments for heart failure include medications, an intra-aortic balloon pump, a ventricular assist device, heart valve replacements, extracorporeal membrane oxygenation (if the heart failure worsens suddenly and especially if an infection was the cause), an artificial heart, or a heart transplant (from a deceased human donor, or from a pig). Some patients may need a liver transplant; an artificial liver can be used for a short period of time (about two weeks or so) as a bridge to a transplant, or until the liver recovers.[citation needed]

See also

References

  1. PMID 12516201
    .
  2. OCLC 1191840836.{{cite book}}: CS1 maint: location missing publisher (link
    )
  3. PMID 22942628
    .
  4. ^ Morales A, Hirsch M, Schneider D, González G. Congestive hepatopathy: the role of the radiologist in the diagnosis. https://doi.org/10.5152/dir.2020.19673
  5. ^ "Congestive Hepatopathy - Hepatic and Biliary Disorders". Merck Manuals Professional Edition. Retrieved 7 January 2020.

External links

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