- Lawrence S Friedman, MD
Lawrence S Friedman, MD
- Section Editor — General Gastroenterology
- Professor of Medicine
- Harvard Medical School
- Tufts University School of Medicine
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
The liver's complex vascular supply and high metabolic activity make it particularly vulnerable to circulatory disturbances. The severity and characteristics of hepatic injury depend upon the blood vessels that are involved and the degree to which injury is related to passive congestion or diminished perfusion .
There are several well-recognized forms of vascular injury to the liver, including Budd-Chiari syndrome, hepatic sinusoidal obstruction syndrome, passive congestion due to heart failure, hepatic infarction, and ischemic hepatitis. Congestive hepatopathy refers to hepatic manifestations attributable to passive hepatic congestion, as occurs in patients with right sided heart failure. Passive congestion often coexists with reduced cardiac output, making their relative contributions to hepatic injury intertwined. (See "Pathogenesis of liver injury in circulatory failure".)
This topic review will focus on passive congestion with a brief discussion on constrictive pericarditis, while discussions on Budd-Chiari syndrome, hepatic sinusoidal obstruction syndrome, ischemic hepatitis, and hepatic infarction are presented separately. (See "Budd-Chiari syndrome: Epidemiology, clinical manifestations, and diagnosis" and "Diagnosis of hepatic sinusoidal obstruction syndrome (veno-occlusive disease) following hematopoietic cell transplantation" and "Ischemic hepatitis, hepatic infarction, and ischemic cholangiopathy".)
Any cause of right-sided heart failure can result in hepatic congestion, including constrictive pericarditis, mitral stenosis, tricuspid regurgitation, cor pulmonale, and cardiomyopathy. Tricuspid regurgitation in particular can be associated with severe hepatic congestion because of the transmission of right ventricular pressure directly into the hepatic veins. Liver dysfunction and passive congestion are common in patients with congenital heart disease and single-ventricle physiology who have undergone the Fontan procedure, which directs systemic venous return to the pulmonary artery with bypass of the right ventricle .
Patients with hepatic congestion are usually asymptomatic. In such patients, hepatic congestion may be suggested only by abnormal liver biochemical tests during routine evaluation.
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