Liver: Chronic venous congesion

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1.    Which part of the liver are affected?  Relate this to the most common cause of this pathology.

Centrilobular areas of hepatocytes undergoing necrosis.  This can be caused by right sided heart failure.  Note that right sided heart failure causes a backlog, hepatic veins being unable to drain blood into IVC, resulting in chronic venous congestion of the liver.

2.    Describe the key histopathological features.

Hepatic sinusoids engorged with blood.  Some parts may undergo fatty change due to liver damage.

3.    What is the gross appearance of the liver?

Grossly, the liver is enlarged, deep red and soft.

Appearance of "nutmeg" liver due to contrast between central congested sinusoidal space and the paler peripheries.

4.    What other abnormalities are likely to be present in

Abdomen � Umbilical-paraumbilical venous system is engorged

Legs � ankle oedema and pronounced varicose veins.

5.    What is the status of the portal venous circulation?

Portal venous circulation is compromised.  Stagnant blood may progress to affect blood exiting the gut.

6.    Is this process reversible?

It depends on the stage.  If condition is not too severe, digitalising the right heart (right heart failure) may reduce the backlog.

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Copyright � Joseph Ong 2003