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Congestive Hepatomegaly

by Nicholas T. Orfanidis, MD

Congestive hepatomegaly is a backup of blood in the liver, resulting from heart failure.

Severe heart failure causes blood to back up from the heart into the inferior vena cava (the large vein that carries blood from the lower parts of the body to the heart). Such congestion increases pressure in the inferior vena cava and other veins that carry blood to it, including the hepatic veins (which drain blood from the liver). If this pressure is high enough, the liver becomes engorged (congested) with blood and malfunctions.

Most people do not have any symptoms. In other people, the congested liver causes abdominal discomfort, which is usually mild. The liver (in the upper right part of the abdomen) is tender and enlarged. In severe cases, the skin and whites of the eyes may turn yellow—a disorder called jaundice (see Jaundice in Adults). Fluid may accumulate in the abdomen—a disorder called ascites (see Ascites). The spleen also tends to enlarge. If congestion is severe and chronic, liver damage or even severe scarring (cirrhosis) develops.

Doctors suspect the disorder in people with heart failure who have typical symptoms. Doctors examine the person and do blood tests to determine how well the liver is functioning and whether it is damaged (liver function tests) and to evaluate blood clotting. The diagnosis is based on symptoms and results of the examination and blood tests. Congestive hepatomegaly is important to identify mainly because it indicates how severe heart failure is.

Management focuses on treating the heart failure (see Heart Failure : Prevention). Such treatment may restore normal liver function.