Hepatic congestion is liver damage caused by blood congestion in the liver. There are acute and chronic courses of the disease. If left untreated, the liver will be completely destroyed in the long term.
What is liver congestion?
Hepatic congestion is a liver disease caused by a build-up of blood in the liver. This backlog disrupts their oxygen supply and leads to the death of liver cells in the short or long term. The backlog of blood is caused by a disrupted outflow of venous blood. Right heart failure is usually present. But lung diseases and thrombosis in the hepatic vein are also possible reasons. For comprehensive guide to hypophosphatasia, please visit growtheology.com.
There are three forms of congested liver. An acute, a subacute and a chronic form can be distinguished. There are often different reasons for the formation of these different forms. However, acute liver congestion can also develop into a chronic form over the long term. A striking feature of congested liver is an enlargement of the organ due to the backlog of blood. Only in the chronic form does the liver appear to have shrunk, although congestion is also present here. The final state of congested liver is usually cirrhosis of the liver, which in the case of congested liver is referred to as cirrhosis cardiaque ( cardiac cirrhosis of the liver ).
The cause of liver congestion is always to be found in the backlog of venous blood in the liver. This backlog can occur for a number of reasons. Right heart failure is usually present. The heart is no longer able to adequately transport the venous blood into the pulmonary circulation. The backlog of venous blood begins in the liver and can affect other organs of the dependent organ system. Thus, congested liver is always a consequence of an underlying disease.
Right heart failure can have several causes. Heart valve defects, tumors, embolisms or chronic lung diseases lead to cardiac insufficiency. Right heart failure refers to the weaker performance of the right ventricle. It is responsible for transporting the venous blood into the pulmonary circulation in order to be able to freshen it up with oxygen again through gas exchange.
Severe chronic lung diseases such as COPD or pulmonary fibrosis increase the resistance of the pulmonary circulation to the venous blood, so that the cardiac output is overtaxed in the long term. Chronic liver congestion develops. Pulmonary embolisms and sudden occlusions of the hepatic veins by blood clots represent acute emergency events that also show the symptom of liver congestion, among other things.
Acute hepatic vein occlusion is also known as Budd-Chiari syndrome. In addition to the sudden development of a blood clot, a tumor that is pressing on the hepatic vein can also be responsible for the hepatic vein occlusion. After the accumulation of blood in the liver tissue, the supply to the liver cells surrounding the central veins is reduced. The metabolism is disturbed and fatty degeneration of the hepatocytes begins. If the congestion lasts for a long time, necrosis of the affected liver cells begins.
Symptoms, Ailments & Signs
Initially, the symptoms of congested liver manifest themselves as discrete symptoms of the underlying disease. This is followed by the classic signs of liver failure, which manifest themselves in the occurrence of jaundice (icterus), coagulation disorders and hepatic coma. However, the courses of the disease vary in severity and depend on whether the form of liver congestion is acute, subacute or chronic.
If left untreated, congestion ends in the complete destruction of the liver tissue. Acute liver congestion shows a dramatic course. The liver swells very quickly, causing acute liver capsule tension pain. The liver is spontaneously very painful when palpated. Macroscopically it appears enlarged with a dark red surface. At the same time, small red dots appear. In the subacute form, the liver appears enlarged and mottled.
This look is also known as the fall foliage pattern. In addition to red spots, white spots also appear. The reddish spots characterize the dilated sinusoids (small blood vessels), while the white spots represent fatty liver parenchyma. At this stage, liver necrosis begins.
In the chronic form of hepatic congestion, the liver appears smaller again, although it should be enlarged according to expectations. However, connective tissue develops in the area of the dead liver tissue. The liver shrinks and hardens. Liver cirrhosis develops.
Diagnosis & course of disease
Ultrasound scans are used to diagnose liver congestion. A greatly enlarged organ with dilated hepatic veins is found. While acute liver congestion appears less hypoechoic than in the normal state, the chronic form of the disease shows compacted, finely humped echo structures.
The values of transaminases, gamma-glutamyltransferase (GGT) and various other values are of interest in the comprehensive laboratory tests. Elevations in these laboratory values indicate disturbances in liver function. The relationship between these laboratory values is of interest for the differential diagnosis from other liver diseases.
A congested liver usually occurs as a result of right heart failure (right heart failure), which has various complications. Consequences of untreated right heart failure are cardiac arrhythmias. In atrial fibrillation, thrombi can easily form in the wall of the atrium, which can then detach and be carried away with the bloodstream.
In the case of the right heart, the blood clots are carried toward the pulmonary vessels and can cause a pulmonary embolism, which is characterized by shortness of breath and crushing chest pain. If untreated, ventricular fibrillation quickly leads to cardiac arrest and, as a result, to immediate cardiac death. The accumulation of blood in the liver causes the organ to enlarge, which can cause pain in the upper right abdomen.
Liver cirrhosis can also develop over time. In this case, the liver is no longer able to synthesize enough proteins and edema and coagulation disorders as well as ascites develop. The blood can no longer be transported properly through the liver, so that it has to be diverted to the spleen.
As a result, the spleen enlarges ( splenomegaly ) and further pain develops. Further immediate circulation results in esophageal varices and hemorrhoids. In addition, in the case of cirrhosis of the liver, the detoxification function is no longer guaranteed, ammonia accumulates more in the blood, which can lead to encephalopathy.
When should you go to the doctor?
Because the liver does not have its own pain receptors, a doctor should be consulted if there is diffuse pain in the upper right abdomen. This pain only occurs when the organ is already enlarged. Increasing tiredness and exhaustion can also often be an alarm signal for acute, subacute or chronic liver congestion. Even if the liver reacts to pressure with spontaneous pain, the decision to see a doctor is very obvious.
Because right heart failure can also lead to liver congestion, heart pain should be discussed directly with an internist or cardiologist. This is particularly necessary when an arrhythmia (heart rhythm disorder) is present. Shortness of breath, combined with heart involvement, can indicate that blood clots are being transported to the pulmonary vessels. Then medical treatment must be initiated immediately.
Anyone who notices yellowing of their skin or mucous membranes should inform their family doctor immediately. If coagulation disorders or signs of jaundice appear over time, a doctor should be consulted immediately.
Treatment & Therapy
Since the congested liver is not an independent disease, but always the consequence of an underlying disorder, the underlying disease must be treated to cure it. It is usually right heart failure, the cause of which has yet to be determined.
it must be noted that the drug metabolism can be disturbed due to the liver disease. This often requires other treatment strategies in addition to drug treatments. In rare cases, surgical measures such as heart or lung operations are also effective.
Outlook & Forecast
Liver congestion is already a serious symptom of liver disease, which is why the prognosis is usually negative. Usually, the underlying disease leads to other symptoms, which further stress the liver and eventually lead to organ failure.
When liver congestion occurs, it is usually no longer possible to treat the cirrhosis of the liver, which is usually the cause. However, the inevitable liver failure can be delayed; how long depends on the type and severity of the underlying disease, the patient’s constitution and possible previous illnesses.
The prospect of liver cirrhosis is determined using the Child-Pugh criteria, which take into account liver function ( blood clotting, bilirubin content, etc.) and possible secondary diseases ( ascites, encephalopathy) and use them to make an accurate prognosis. The chances of recovery from a causative ascites are around 50%, with further inflammation making a very severe course more likely.
The prospect of a congested liver is also worsened by possible complications such as bleeding or the formation of cysts and tumors in the liver. The final prognosis should always be made by a doctor.
To prevent liver congestion, all recommendations that are also made to avoid cardiovascular and lung diseases apply. A healthy lifestyle with a balanced diet, plenty of exercise and not smoking or alcohol reduces the risk of liver congestion.
In most cases, people with congested liver only have limited direct follow-up care available, so ideally people should see a doctor at the first signs and symptoms of this disease. It cannot heal on its own, so a doctor should be consulted at an early stage. As a rule, an early diagnosis of this disease always has a very positive effect on the further course.
As a rule, in the case of congested liver, the underlying disease must be treated properly so that further complications and symptoms do not occur. In many cases, an operation is necessary. After that, the person concerned should definitely rest and rest.
In any case, physical exertion or stressful activities should be avoided in order not to unnecessarily burden the body. Regular check-ups by a doctor are also very important after the procedure. In general, a healthy lifestyle with a balanced diet can also have a positive effect on the further course of the disease in the case of congested liver.
You can do that yourself
Because liver congestion is not caused by an independent reason, measures for the general treatment of the underlying disease should be taken by the person concerned. The corresponding action steps depend on the specific disease.
The same recommendations that are given for the prevention of cardiovascular and lung diseases apply to the prevention of a congested liver. A healthy lifestyle is recommended for those affected. This includes a healthy and balanced diet. Above all, a lot of fresh fruit and vegetables are ideal here, and excessive consumption of fast food and ready-made products should be avoided. Getting enough exercise and getting enough sleep can also reduce the risk of liver congestion. Nicotine, alcohol or drugs should be avoided in the interest of prevention.
In addition, those affected should have check-ups at regular intervals and consult a doctor immediately if the first symptoms appear. Avoiding stress also has a positive effect. If the patient is exposed to a high level of stress, relaxation-promoting measures such as long walks, yoga or various meditation techniques can be used.