In hepatology

Hepatology

Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders. Etymologically the word Hepatology is formed of ancient Greek hepar or hepato- meaning ' liver' and suffix -logia meaning 'word' or 'speech'...

, congestive hepatopathy, also known as nutmeg liver and chronic passive congestion of the liver, is liver

Liver

The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

 dysfunction due to venous congestion, usually cardiac dysfunction, i.e. right heart failure or (less specifically) congestive heart failure

Congestive heart failure

Heart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...

.

The gross pathological

Gross pathology

Gross pathology refers to macroscopic manifestations of disease in organs, tissues, and body cavities. The term is commonly used by anatomical pathologists to refer to diagnostically useful findings made during the gross examination portion of surgical specimen processing or an autopsy.It's vital...

 appearance of a liver affected by chronic passive congestion is "speckled" like a grated nutmeg

Nutmeg

The nutmeg tree is any of several species of trees in genus Myristica. The most important commercial species is Myristica fragrans, an evergreen tree indigenous to the Banda Islands in the Moluccas of Indonesia...

 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

Fibrosis

Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...

, which is often called cardiac cirrhosis.

Etiology

Increased pressure in the sublobular branches of the hepatic vein

Hepatic vein

In human anatomy, the hepatic veins are the blood vessels that drain de-oxygenated blood from the liver and blood cleaned by the liver into the inferior vena cava....

s causes an engorgement of venous blood, and is most frequently due to chronic cardiac lesions, especially those affecting the right heart, the blood being dammed back in the inferior vena cava

Inferior vena cava

The inferior vena cava , also known as the posterior vena cava, is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart....

 and hepatic veins. Central regions of the hepatic lobules are red/brown and stand out against the noncongested, tan-coloured liver. Centrilobular necrosis occurs. Macroscopically, the liver has a pale and spotty appearance in affected areas, as stasis of the blood causes pericentral hepatocytes (liver cells surrounding the periportal venules 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 pulmonary lesions, such as chronic interstitial pneumonia, pleural effusion

Pleural effusion

Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

s, and intrathoracic tumors.

Symptoms

Symptoms depend largely upon the primary lesions giving rise to the condition. In addition to the cardiac or pulmonary symptoms, there will be a sense of fullness and tenderness in the right hypochondriac region. Gastrointestinal catarrh

Catarrh

Catarrh is a disorder of inflammation of the mucous membranes in one of the airways or cavities of the body. It can result in a thick exudate of mucus and white blood cells caused by the swelling of the mucous membranes in the head in response to an infection...

 is usually present, and hematemesis

Hematemesis

Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the latter is more common.-Signs:...

 may occur. There is usually more or less jaundice

Jaundice

Jaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...

. Owing to portal obstruction, ascites

Ascites

Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver...

 occurs, followed later by general dropsy. The stools are light or clay-colored, and the urine is colored by bile

Bile

Bile or gall is a bitter-tasting, dark green to yellowish brown fluid, produced by the liver of most vertebrates, that aids the process of digestion of lipids in the small intestine. In many species, bile is stored in the gallbladder and upon eating is discharged into the duodenum...

. On palpation, the liver is found enlarged and tender, sometimes extending several inches below the costal margin of the ribs.

Treatment

Treatment is directed largely to removing the cause, or, where that is impossible, to modifying its effects. Thus, therapy aimed at improving right cardiac 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.