Nutmeg liver

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Nutmeg liver Classification and external resources
ICD-9	573.8

WikiDoc Resources for Nutmeg liver
Articles
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Powerpoint slides on Nutmeg liver Images of Nutmeg liver Photos of Nutmeg liver Podcasts & MP3s on Nutmeg liver Videos on Nutmeg liver
Evidence Based Medicine
Cochrane Collaboration on Nutmeg liver Bandolier on Nutmeg liver TRIP on Nutmeg liver
Clinical Trials
Ongoing Trials on Nutmeg liver at Clinical Trials.gov Trial results on Nutmeg liver Clinical Trials on Nutmeg liver at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Nutmeg liver NICE Guidance on Nutmeg liver NHS PRODIGY Guidance FDA on Nutmeg liver CDC on Nutmeg liver
Books
Books on Nutmeg liver
News
Nutmeg liver in the news Be alerted to news on Nutmeg liver News trends on Nutmeg liver
Commentary
Blogs on Nutmeg liver
Definitions
Definitions of Nutmeg liver
Patient Resources / Community
Patient resources on Nutmeg liver Discussion groups on Nutmeg liver Patient Handouts on Nutmeg liver Directions to Hospitals Treating Nutmeg liver Risk calculators and risk factors for Nutmeg liver
Healthcare Provider Resources
Symptoms of Nutmeg liver Causes & Risk Factors for Nutmeg liver Diagnostic studies for Nutmeg liver Treatment of Nutmeg liver
Continuing Medical Education (CME)
CME Programs on Nutmeg liver
International
Nutmeg liver en Espanol Nutmeg liver en Francais
Businness
Nutmeg liver in the Marketplace Patents on Nutmeg liver
Experimental / Informatics
List of terms related to Nutmeg liver

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Nutmeg liver is the pathological appearance of the liver caused by chronic passive congestion of the liver secondary to right heart failure. The liver appears "speckled" like a grated nutmeg kernel, from the dilated, congested central veins (dark spots) and paler, unaffected surrounding liver tissue. When severe and longstanding, hepatic congestion can lead to cirrhosis, a state described as cardiac cirrhosis.^[1]

Etiology

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, the blood being dammed back in the inferior vena cava and hepatic veins. Central regions of the hepatic lobes are red/brown and stand out against the non-congested tan colored liver. Centrilobular necrosis occurs. Macroscopically 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 effusions, and intrathoracic tumors.

Symptoms

These depend largely upon the primary lesions giving rise to it. In addition to the cardiac or pulmonary symptoms, there will be a sense of fullness and tenderness in the right hypochondriac region. Gastro-intestinal catarrh is usually present, and hematemesis may occur. There is usually more or less jaundice. Owing to portal obstruction, ascites occurs, followed later by general dropsy. 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.

Treatment

This is directed largely to removing the cause, or, where that is impossible, to modifying its effects. Thus hygienic and dietary measures must be carried out, even although it is due to valvular lesions.

Pathological Findings

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology

See also

• Ischemic hepatitis

References

v • d • e Digestive system - Digestive disease - Gastroenterology (primarily K20-K93, 530-579)
Upper GI tract	Esophagus Esophagitis (Candidal) - Boerhaave syndrome - UES (Zenker's diverticulum) - LES (Barrett's esophagus, Mallory-Weiss syndrome) - Esophageal motility disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD) - Esophageal stricture Stomach Gastritis (Atrophic, Ménétrier's disease, Gastroenteritis) - Peptic (gastric) ulcer/Dieulafoy's lesion - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy - Gastric antral vascular ectasia - Gastric dumping syndrome
Intestinal/ enteropathy	Small intestine/ (duodenum/jejunum/ileum) Enteritis (Duodenitis, Jejunitis, Ileitis) Peptic (duodenal) ulcer Malabsorption: Coeliac - Tropical sprue - Blind loop syndrome - Whipple's - Short bowel syndrome - Steatorrhea Large intestine (appendix/colon) Appendicitis - Colitis (Pseudomembranous, Ulcerative, Ischemic) Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie syndrome) Megacolon/Toxic megacolon - Diverticulitis/Diverticulosis Large and/or small Enterocolitis - IBD (Crohn's disease) vascular: Abdominal angina - Mesenteric ischemia - Angiodysplasia Motility/functional: Ileus/Bowel obstruction (Intussusception, Volvulus) - Constipation - Diarrhea Rectum/anus Proctitis (Radiation proctitis) - Proctalgia fugax - Rectal prolapse - Anal fissure/Anal fistula - Anal abscess
Accessory	Liver Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis) - Cirrhosis (PBC) - Fatty liver (NASH) - vascular (Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver) - Alcoholic liver disease - Liver failure (Hepatic encephalopathy, Acute liver failure) - Liver abscess - Hepatorenal syndrome - Peliosis hepatis Gallbladder Cholecystitis - Gallstones - common bile duct (Choledocholithiasis, Biliary dyskinesia) - Cholesterolosis - Rokitansky-Aschoff sinuses - Postcholecystectomy syndrome Biliary tree Cholangitis (PSC, Ascending) - Cholestasis/Mirizzi's syndrome - Biliary fistula - Haemobilia Pancreatic Pancreatitis (Acute, Chronic, Hereditary) - Pancreatic pseudocyst - Exocrine pancreatic insufficiency - Pancreatic fistula
Hernia	Diaphragmatic: Congenital diaphragmatic - Hiatus Abdominal hernia: Inguinal (Indirect, Direct) - Umbilical - Incisional - Femoral Obturator hernia - Spigelian hernia
Peritoneal	Peritonitis (Spontaneous bacterial peritonitis) - Hemoperitoneum - Pneumoperitoneum
GI bleeding	Upper (Hematemesis, Melena) - Lower (Hematochezia)
See also congenital, neoplasia

v • d • e WikiDoc Research Resources for Nutmeg liver (Click show to right to view)
Articles on Nutmeg liver	Most recent articles on Nutmeg liver • Most cited articles on Nutmeg liver • Review articles on Nutmeg liver • Articles on Nutmeg liver in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Nutmeg liver	Powerpoint slides on Nutmeg liver • Images of Nutmeg liver • Photos of Nutmeg liver • Podcasts & MP3s on Nutmeg liver • Videos on Nutmeg liver
Evidence Based Medicine Regarding Nutmeg liver	Cochrane Collaboration on Nutmeg liver • Bandolier on Nutmeg liver • TRIP on Nutmeg liver
Cost Effectiveness of Nutmeg liver	Cost Effectiveness of Nutmeg liver
Clinical Trials Involving Nutmeg liver	Ongoing Trials on Nutmeg liver at Clinical Trials.gov • Trial results on Nutmeg liver • Clinical Trials on Nutmeg liver at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Nutmeg liver	US National Guidelines Clearinghouse on Nutmeg liver • NICE Guidance on Nutmeg liver • NHS PRODIGY Guidance • FDA on Nutmeg liver • CDC on Nutmeg liver
Textbook Information on Nutmeg liver	Books and Textbook Information on Nutmeg liver
Pharmacology Resources on Nutmeg liver	Dosing of Nutmeg liver • Drug interactions with Nutmeg liver • Side effects of Nutmeg liver • Allergic reactions to Nutmeg liver • Overdose information on Nutmeg liver • Carcinogenicity information on Nutmeg liver • Nutmeg liver in pregnancy • Pharmacokinetics of Nutmeg liver •
Genetics, Pharmacogenomics, and Proteinomics of Nutmeg liver	Genetics of Nutmeg liver • Pharmacogenomics of Nutmeg liver • Proteomics of Nutmeg liver
Newstories on Nutmeg liver	Nutmeg liver in the news • Be alerted to news on Nutmeg liver • News trends on Nutmeg liver
Commentary on Nutmeg liver	Blogs on Nutmeg liver
Patient Resources on Nutmeg liver	Patient resources on Nutmeg liver • Discussion groups on Nutmeg liver • Patient Handouts on Nutmeg liver • Directions to Hospitals Treating Nutmeg liver • Risk calculators and risk factors for Nutmeg liver
Healthcare Provider Resources on Nutmeg liver	Symptoms of Nutmeg liver • Causes & Risk Factors for Nutmeg liver • Diagnostic studies for Nutmeg liver • Treatment of Nutmeg liver
Continuing Medical Education (CME) Programs on Nutmeg liver	CME Programs on Nutmeg liver
International Resources on Nutmeg liver	Nutmeg liver en Espanol • Nutmeg liver en Francais
Business Resources on Nutmeg liver	Nutmeg liver in the Marketplace • Patents on Nutmeg liver
Informatics Resources on Nutmeg liver	List of terms related to Nutmeg liver

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .