congestive hepatopathy

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.{{cn|date=November 2020}}

File:Muskatnussleber - 69jw - CT axial und coronar pv - 001.jpg

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.{{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}}

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.{{cn|date=May 2022}}

It is diagnosed with laboratory testing, including liver function tests, and radiology imaging, including ultrasounds.{{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}}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

Treatment is directed largely to removing the cause, or, where that is impossible, to modifying effects of the heart failure.{{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}} 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}}

• Ischemic hepatitis

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Category:Diseases of liver