Congestive hepatopathy: Difference between revisions
m Dating maintenance tags: {{Cn}} |
Ira Leviton (talk | contribs) Fixed a reference. Please see Category:CS1 maint: others. |
||
| (8 intermediate revisions by 8 users not shown) | |||
| Line 1: | Line 1: | ||
{{More medical citations needed|date=September 2015}} |
{{More medical citations needed|date=September 2015}} |
||
{{Infobox medical condition (new) |
{{Infobox medical condition (new) |
||
| name = Congestive hepatopathy |
| name = Congestive hepatopathy |
||
| image = Congestive hepatopathy high mag.jpg |
| image = Congestive hepatopathy high mag.jpg |
||
| caption = [[Micrograph]] of '''congestive hepatopathy''' demonstrating perisinusoidal [[fibrosis]] and centrilobular (zone III) sinusoidal dilation. [[Liver]] [[biopsy]]. [[Trichrome stain]]. |
| caption = [[Micrograph]] of '''congestive hepatopathy''' demonstrating perisinusoidal [[fibrosis]] and centrilobular (zone III) sinusoidal dilation. [[Liver]] [[biopsy]]. [[Trichrome stain]]. |
||
| |
| |
||
| pronounce = |
| pronounce = |
||
| field = |
| field = |
||
| synonyms = '''Nutmeg liver''' and '''Chronic passive congestion of the liver''' |
| synonyms = '''Nutmeg liver''' and '''Chronic passive congestion of the liver''' |
||
| symptoms = |
| symptoms = |
||
| complications = |
| complications = |
||
| onset = |
| onset = |
||
| duration = |
| duration = |
||
| types = |
| types = |
||
| causes = |
| causes = |
||
| risks = |
| risks = |
||
| diagnosis = |
| diagnosis = |
||
| differential = |
| differential = |
||
| prevention = |
| prevention = |
||
| treatment = |
| treatment = |
||
| medication = |
| medication = |
||
| prognosis = |
| prognosis = |
||
| frequency = |
| frequency = |
||
| deaths = |
| deaths = |
||
}} |
}} |
||
'''Congestive hepatopathy''', is [[liver]] dysfunction due to venous congestion, usually due to [[congestive heart failure]]. The [[gross pathology|gross pathological]] appearance of a liver affected by chronic passive congestion is "speckled" like a grated [[nutmeg]] kernel; the dark [[liver spot|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]].<ref>{{cite journal |vauthors=Giallourakis CC, Rosenberg PM, Friedman LS |title=The liver in heart failure |journal=Clin Liver Dis |volume=6 |issue=4 |pages=947–67, viii–ix |year=2002 |pmid=12516201 |doi=10.1016/S1089-3261(02)00056-9}}</ref> |
'''Congestive hepatopathy''', is [[liver]] dysfunction due to venous congestion, usually due to [[congestive heart failure]]. The [[gross pathology|gross pathological]] appearance of a liver affected by chronic passive congestion is "speckled" like a grated [[nutmeg]] kernel; the dark [[liver spot|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]].<ref>{{cite journal |vauthors=Giallourakis CC, Rosenberg PM, Friedman LS |title=The liver in heart failure |journal=Clin Liver Dis |volume=6 |issue=4 |pages=947–67, viii–ix |year=2002 |pmid=12516201 |doi=10.1016/S1089-3261(02)00056-9}}</ref> |
||
| Line 31: | Line 31: | ||
== Pathophysiology == |
== Pathophysiology == |
||
[[File:Muskatnussleber - 69jw - CT axial und coronar pv - 001.jpg|thumb|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.]] |
[[File:Muskatnussleber - 69jw - CT axial und coronar pv - 001.jpg|thumb|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 vein]]s causes an engorgement of venous blood, and is most frequently due to chronic cardiac [[ |
Increased pressure in the sublobular branches of the [[hepatic vein]]s causes an engorgement of venous blood, and is most frequently due to chronic cardiac [[wikt:lesion|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, [[wikt:tan|tan]]-coloured liver. Centrilobular necrosis occurs.<ref>{{Cite book |url=https://www.worldcat.org/oclc/1191840836 |title=Robbins & Cotran pathologic basis of disease |date=2021 |first1=Vinay |last1=Kumar |first2=Abul K. |last2=Abbas |first3=Jon C. |last3=Aster |others=James A. Perkins (illustrator) |isbn=978-0-323-53113-9 |edition=Tenth |location=Philadelphia, PA |oclc=1191840836}}</ref> |
||
Macroscopically, the liver has a pale and spotty appearance in affected areas, as stasis of the blood causes pericentral [[hepatocyte]]s (liver cells surrounding the central venule of the liver) to become deoxygenated compared to the relatively better-oxygenated periportal hepatocytes adjacent to the hepatic [[arteriole]]s. This retardation of the blood also occurs in lung lesions, such as chronic [[interstitial pneumonia]], [[pleural effusion]]s, and intrathoracic tumors. |
Macroscopically, the liver has a pale and spotty appearance in affected areas, as stasis of the blood causes pericentral [[hepatocyte]]s (liver cells surrounding the central venule of the liver) to become deoxygenated compared to the relatively better-oxygenated periportal hepatocytes adjacent to the hepatic [[arteriole]]s. This retardation of the blood also occurs in lung lesions, such as chronic [[interstitial pneumonia]], [[pleural effusion]]s, and intrathoracic tumors.{{cn|date=May 2022}} |
||
==Diagnosis== |
==Diagnosis== |
||
It is diagnosed with laboratory testing, including [[liver function tests]], and radiology imaging, including [[ultrasound]]s.<ref>{{cite journal |last1=Alvarez |first1=Alicia M. |last2=Mukherjee |first2=Debabrata |title=Liver Abnormalities in Cardiac Diseases and Heart Failure |journal=The International Journal of Angiology |volume=20 |issue=3 |pages=135–142 |doi=10.1055/s-0031-1284434 |pmid=22942628 |pmc=3331650 |date=2011}}</ref> |
It is diagnosed with laboratory testing, including [[liver function tests]], and radiology imaging, including [[ultrasound]]s.<ref>{{cite journal |last1=Alvarez |first1=Alicia M. |last2=Mukherjee |first2=Debabrata |title=Liver Abnormalities in Cardiac Diseases and Heart Failure |journal=The International Journal of Angiology |volume=20 |issue=3 |pages=135–142 |doi=10.1055/s-0031-1284434 |pmid=22942628 |pmc=3331650 |date=2011}}</ref><ref>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</ref> |
||
== Treatment == |
== Treatment == |
||
Treatment is directed largely to removing the cause, or, where that is impossible, to modifying effects of the heart failure.<ref>{{cite web |title=Congestive Hepatopathy - Hepatic and Biliary Disorders |url=https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/vascular-disorders-of-the-liver/congestive-hepatopathy |website=Merck Manuals Professional Edition | |
Treatment is directed largely to removing the cause, or, where that is impossible, to modifying effects of the heart failure.<ref>{{cite web |title=Congestive Hepatopathy - Hepatic and Biliary Disorders |url=https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/vascular-disorders-of-the-liver/congestive-hepatopathy |website=Merck Manuals Professional Edition |access-date=7 January 2020}}</ref> 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.{{cn|date=May 2022}} |
||
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.{{cn|date=May 2022}} |
|||
==See also== |
==See also== |
||
| Line 50: | Line 52: | ||
== External links == |
== External links == |
||
{{Medical resources |
{{Medical resources |
||
| DiseasesDB = |
| DiseasesDB = |
||
| ICD10 = {{ICD10|K76.1}} |
| ICD10 = {{ICD10|K76.1}} |
||
| ICD9 = {{ICD9|573.8}} |
| ICD9 = {{ICD9|573.8}} |
||
| ICDO = |
| ICDO = |
||
| OMIM = |
| OMIM = |
||
| MedlinePlus = |
| MedlinePlus = |
||
| eMedicineSubj = |
| eMedicineSubj = |
||
| eMedicineTopic = |
| eMedicineTopic = |
||
| MeshID = |
| MeshID = |
||
}} |
}} |
||
{{Digestive system diseases}} |
{{Digestive system diseases}} |
||
Latest revision as of 13:53, 24 March 2023
 | This article needs more reliable medical references for verification or relies too heavily on primary sources. (September 2015) |  |
| Congestive hepatopathy | |
|---|---|
| Other names | Nutmeg liver and Chronic passive congestion of the liver |
 | |
| Micrograph of congestive hepatopathy demonstrating perisinusoidal fibrosis and centrilobular (zone III) sinusoidal dilation. Liver biopsy. Trichrome stain. | |
| Specialty | Gastroenterology, hepatology  |
Congestive hepatopathy, is liver dysfunction due to venous congestion, usually due to 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
[edit]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
[edit]
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 hepatocytes (liver cells surrounding the central venule of the liver) to become deoxygenated compared to the relatively better-oxygenated periportal hepatocytes adjacent to the hepatic arterioles. This retardation of the blood also occurs in lung lesions, such as chronic interstitial pneumonia, pleural effusions, and intrathoracic tumors.[citation needed]
Diagnosis
[edit]It is diagnosed with laboratory testing, including liver function tests, and radiology imaging, including ultrasounds.[3][4]
Treatment
[edit]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
[edit]References
[edit]- ^ Giallourakis CC, Rosenberg PM, Friedman LS (2002). "The liver in heart failure". Clin Liver Dis. 6 (4): 947–67, viii–ix. doi:10.1016/S1089-3261(02)00056-9. PMID 12516201.
- ^ Kumar, Vinay; Abbas, Abul K.; Aster, Jon C. (2021). Robbins & Cotran pathologic basis of disease. James A. Perkins (illustrator) (Tenth ed.). Philadelphia, PA. ISBN 978-0-323-53113-9. OCLC 1191840836.
{{cite book}}: CS1 maint: location missing publisher (link) - ^ Alvarez, Alicia M.; Mukherjee, Debabrata (2011). "Liver Abnormalities in Cardiac Diseases and Heart Failure". The International Journal of Angiology. 20 (3): 135–142. doi:10.1055/s-0031-1284434. PMC 3331650. PMID 22942628.
- ^ 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
- ^ "Congestive Hepatopathy - Hepatic and Biliary Disorders". Merck Manuals Professional Edition. Retrieved 7 January 2020.
