Chronic passive congestion of the liver

Gastroenterology

Clinicals - History

Fact Explanation
A predisposing condition The commonest predisposing conditions are the diseases of the right heart. i.e. right heart failure due to pulmonary hypertension, congestive cardiac failure. The reason behind congestive hepatopathy being a result of right heart failure is that, since the back pressure of systemic veins, venous blood is congested in the liver and there is a chronic ischemia going on if the congestion keeps on for a long time. A predisposing condition
The commonest predisposing conditions are the diseases of the right heart. i.e. right heart failure due to pulmonary hypertension, congestive cardiac failure. The reason behind congestive hepatopathy being a result of right heart failure is that, since the back pressure of systemic veins, venous blood is congested in the liver and there is a chronic ischemia going on if the congestion keeps on for a long time.
Sense of fullness in the upper abdomen Due to hepatomegaly in congestion. Sense of fullness in the upper abdomen
Due to hepatomegaly in congestion.
Upper abdominal pain Due to the stretching of the liver capsule. Upper abdominal pain
Due to the stretching of the liver capsule.
Coughing out blood stained sputum Due to pulmonary venous congestion due to left sided heart failure. Coughing out blood stained sputum
Due to pulmonary venous congestion due to left sided heart failure.
Yellow discoloration of eyes, pale stools and dark urine Not common, and due to periportal necrosis and centrilobular fibrosis. Yellow discoloration of eyes, pale stools and dark urine
Not common, and due to periportal necrosis and centrilobular fibrosis.
Swelling of the abdomen Cirrhosis is rare but present due to long standing congestion. Swelling of the abdomen
Cirrhosis is rare but present due to long standing congestion.
Features of right heart failure i.e. Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, reduced exercise tolerance, lethargy, fatigue, nocturnal cough, wheeze, ankle swelling, anorexia. Features of right heart failure
i.e. Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, reduced exercise tolerance, lethargy, fatigue, nocturnal cough, wheeze, ankle swelling, anorexia.

Clinicals - Examination

Fact Explanation
Icterus Due to hyperbilirubinemia in cirrhosis. Icterus
Due to hyperbilirubinemia in cirrhosis.
Tender hepatomegaly Due to stretching of the liver capsule. Tender hepatomegaly
Due to stretching of the liver capsule.
Ascites Due sinusoidal portal hypertension and hepatic insufficiency in cirrhosis. Ascites
Due sinusoidal portal hypertension and hepatic insufficiency in cirrhosis.
Features of right heart failure Look for signs of right heart failure. i.e. cachexia and muscle wasting, elevated jugular venous pressure, right ventricular heave, crepitations or wheeze, Tachycardia Pulsus alternans, edema. Features of right heart failure
Look for signs of right heart failure. i.e. cachexia and muscle wasting, elevated jugular venous pressure, right ventricular heave, crepitations or wheeze, Tachycardia Pulsus alternans, edema.

Investigations - Diagnosis

Fact Explanation
Liver function tests i.e. Transaminases, bilirubin, alkaline phasphatase, gamma GT: all of those can be mildly elevated with low serum albumin in cardiac cirrhosis. Liver function tests
i.e. Transaminases, bilirubin, alkaline phasphatase, gamma GT: all of those can be mildly elevated with low serum albumin in cardiac cirrhosis.
Prothrombin time PT/INR is mildly elevated because of reduced synthesis of proteins from the liver. Prothrombin time
PT/INR is mildly elevated because of reduced synthesis of proteins from the liver.
Echocardiography Can help in diagnosing the cardiac cause of liver failure. i.e. right heart ejection dysfunction. Echocardiography
Can help in diagnosing the cardiac cause of liver failure. i.e. right heart ejection dysfunction.
Chest X-ray Look for evidence of cardiac dysfunction or pulmonary fibrosis. i.e. cardiomegaly Chest X-ray
Look for evidence of cardiac dysfunction or pulmonary fibrosis. i.e. cardiomegaly
Histology The expected findings are centrilobular parenchymal atrophy, sinusoidal dilation, and perisinusoidal fibrosis. Histology
The expected findings are centrilobular parenchymal atrophy, sinusoidal dilation, and perisinusoidal fibrosis.

Investigations - Management

Fact Explanation
Complete blood count As preparation for procedures, anemia or thrombocytopenia should be corrected immediately before any procedures. Complete blood count
As preparation for procedures, anemia or thrombocytopenia should be corrected immediately before any procedures.

Management - Supportive

Fact Explanation
Educate the patient Educate the family and the patient about the condition, it's prognosis and the importance of adherence to treatments. Educate the patient
Educate the family and the patient about the condition, it's prognosis and the importance of adherence to treatments.
Treat the underlying condition Treat the disease of the heart or lungs which predisposed the hepatopathy. i.e. congestive cardiac failure, pulmonary hypertension. Treat the underlying condition
Treat the disease of the heart or lungs which predisposed the hepatopathy. i.e. congestive cardiac failure, pulmonary hypertension.

Management - Specific

Fact Explanation
Salt restriction There is a positive sodium balance in heart failure and cirrhosis both, so it is important to restrict sodium intake by reducing dietary salt intake. Salt restriction
There is a positive sodium balance in heart failure and cirrhosis both, so it is important to restrict sodium intake by reducing dietary salt intake.

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