SFGH am report pearls 11.6 – congestive hepatopathy

Congestive hepatopathy:

  • can develop secondary to any form of right-sided heart failure
  • symptoms: many are asymptomatic, others present with jaundice, RUQ discomfort, ascites
  • exam:
    • enlarged liver: (normal liver span ~10 cm by liver dullness)
    • hepatojugular reflex usually present
    • pulsatile liver in significant tricuspid regurgitation
    • evidence of CHF
  • lab findings:
    • elevated bilirubin (usually <3, can be marked if severe acute heart failure)
    • alk phos usually normal (as opposed to in biliary obstruction)
    • elevated aminotransferases (usually <3x normal, can be marked if hypotension)
  • pathophysiology:
    • “nutmeg liver”: central sinusoidal congestion and bleeding around enlarged hepatic veins, with contrasting yellow areas of normal liver
    • if chronic or recurrent, fibrosis/cirrhosis can result
  • Treatment: treat the underlying heart failure

Differential diagnosis of diffuse thickening of the gallbladder wall:

  • pseudothickening in a postprandial state, cholecystitis (acute or chronic), gallbladder carcinoma, adenomyomatosis
  • secondary gallbladder involvement: liver dysfunction, heart failure, kidney failure (uncertain pathophysiology), opportunistic infections

Vriesman et al.  Diffuse Gallbladder Wall Thickening: Differential diagnosis.  AJR. 2007. 188;2.

Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis 2002; 6:947.



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