Nutmeg liver

Jump to navigation Jump to search
Nutmeg liver
ICD-9 573.8

WikiDoc Resources for Nutmeg liver

Articles

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

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

Business

Nutmeg liver in the Marketplace

Patents on Nutmeg liver

Experimental / Informatics

List of terms related to Nutmeg liver

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: Cardiac cirrhosis

Overview

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]

Pathophysiology

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.

Gross Pathology

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.

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



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.


See also

References

  1. 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.

Template:Digestive system diseases


Template:WH Template:WikiDoc Sources