Chronic Hepatic Congestion

  • Chronic Hepatic Congestion is an example of congestion caused by chronic right heart failure superimposed on top of hypotension which may be due to left heart failure or septic shock. As in acute hepatic congestion, right heart failure causes backup and thus congestion of blood in the hepatic sinusoid with a "Centrilobular Pattern". However, in chronic hepatic congestion, hypotension reduces total blood flow into the liver, exacerbating hepatic hypoxia. Therefore, rather than simply centrilobular degeneration, hepatocytes near the terminal hepatic venule undergo ischemic necrosis (i.e. Centrilobular Necrosis). Grossly, this gives the liver a mottled appearance described as "Nutmeg Liver". If this situation endures chronically, the centrilobular necrosis is slowly remodeled to a centrilobular fibrosis which has historically been called "Cardiac Cirrhosis" although references to cirrhosis are a bit of a misnomer as these morphologies are easily distinguished and not etiopathogenically related.