Nutmeg liver is a consequence of chronic congestive venous plethora of internal organs. This condition affects not only the digestive system, but also the heart, lungs, kidneys and brain.
Classification
Morphologically, there are three stages of changes occurring in the liver as the disease progresses:
- Nutmeg liver: against the background of fatty degeneration of cells (yellow), dilated vessels are visible (dark red).
- Congestive Fibrosis: Tissue is denser due to ingrowth of connective tissue. Blood impregnates the parenchyma of the organ, and foci of sclerosis also appear.
- Cardiac cirrhosis: the surface of the organ becomes lumpy.
Etiology
Violation of the outflow of blood from the portal vein system leads to the formation of such a phenomenon as nutmeg liver. The causes of stagnation are dysfunction of the ventricles of the heart and a decrease in venous return. These are manifestations of heart failure, and often they accompany coronary heart disease. Increased pressure in the venous system, as well as the accumulation and stagnation of blood in the vessels, prevent effective blood flow in the organs.
Epidemiology
The disease is not related to gender or age. But statistically, men of senile and advanced age most often suffer from it. Most often, only at an autopsy can it be determined that the patient had nutmeg liver. Pathoanatomy can provide answers to questions that are of interest to the attending physician. To do this, the organs are not only visually assessed, but also sent for histological examination.
Risk factors for developing liver pathology are physical inactivity, poor diet, bad habits, a history of heart disease, and advanced age.
Clinic
In most cases, the symptoms of heart failure dominate the clinical picture of the disease, so the patient may not suspect that he has problems with the liver. Nutmeg liver, like any other cirrhosis, is manifested by pain in the right hypochondrium, yellowness of the skin and mucous membranes, swelling in the legs at the end of the day, ascites (accumulation of fluid in the abdominal cavity). But these are all indirect signs. A 100% diagnosis can only be made after an autopsy, because none of the modern imaging methods can show whether the organ resembles nutmeg. On palpation, the liver will be dense, its edge is rounded and protrudes from under the costal arch.
Diagnosis
In order to make a diagnosis of "chronic passive venous plethora", you must:
1. Confirm Availabilityheart failure (instrumental or physical examination):
- chest X-ray (indicates a change in the heart, venous congestion in the lungs or the presence of an effusion);
- Doppler examination of the heart and inferior vena cava (to identify the causes of heart disease);
- CT or MRI;
- ECG.
2. Perform laboratory tests such as blood chemistry and liver tests:
- blood bilirubin rises;
- moderately increased transaminases (ALT, AST);
- increase in alkaline phosphatase;
- reduce albumin and prolong clotting time.
3. To resort to instrumental diagnostics in order to morphologically establish the fact of liver degeneration. These studies include:
- laparocentesis (aspiration of free fluid from the abdominal cavity) to determine the cause of ascites;
- puncture biopsy (to confirm the diagnosis of nutmeg liver, a micropreparation can be made during the patient's lifetime).
Comparative diagnosis is carried out with diseases such as alcoholic cirrhosis, heart cancer, hemochromatosis, inferior vena cava thrombosis and portal hypertension. Do not forget about viral diseases of the liver - hepatitis A, B, C, D, E. In addition, there is a possibility of a parasitic disease.
Complications
Nutmeg liver and cardiac cirrhosis that causes it do not affect the outcome of cardiacinsufficiency. Cases in which acute liver failure caused death are isolated and cannot be considered indicative. Blood clotting disorders are also quite rare, although not unprecedented. Some experts suspect that there is a link between cirrhosis of the liver and the occurrence of malignant neoplasms of the liver, but this theory has not yet been proven.
Treatment
Drug therapy should be aimed at eliminating the underlying disease, that is, heart failure. And cirrhosis itself has no specific therapy. In addition, the patient is advised to follow a s alt-restricted diet and change his daily routine in order to get good sleep, be in the fresh air and get enough physical activity. These simple manipulations will help reduce blood pressure in the main vessels, including the portal vein.
Symptomatic therapy consists of taking diuretics (to reduce the amount of fluid in the abdominal cavity), as well as beta-blockers and ACE inhibitors (to normalize the heart).
Surgical treatment, as a rule, is not carried out. This is associated with a great risk for the patient and does not justify itself. Sometimes a doctor may decide to bypass the intrahepatic portal vein, but this can lead to severe right ventricular heart failure and pulmonary edema due to a sharply increased venous return.
