Nutmeg liver





Nutmeg liver refers to the pathological appearance of the liver caused by chronic passive congestion of the liver secondary to right heart failure. 



The liver appears speckled from the dilated, congested central veins and paler of unaffected surrounding liver tissue. 



Prolonged hepatic congestion can lead cardiac cirrhosis.



The increased pressure in the sublobular branches of the hepatic veins causes an engorgement of venous blood.



The increased pressure is most frequently due to chronic cardiac lesions, especially of the affecting the right heart with the blood being dammed back in the inferior vena cava and hepatic veins.



Centrilobular liver necrosis occurs. 



The liver appears pale and spotty in appearance in affected areas as stasis of the blood causes pericentral hepatocytes to become deoxygenated compared to the relatively better oxygenated periportal hepatocytes adjacent to the hepatic arterioles. 



Nutmeg liver symptoms depend largely upon its primary cause: cardiac or pulmonary symptoms, sense of fullness and tenderness in the right hypochondriac region. 



May be associated with hematemesis.



Patients are usually jaundiced, owing to portal obstruction, with ascites and anasarca.



The stools are light or clay colored, and the urine is colored by bile. 



The liver is found enlarged and tender.


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