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Congestive Hepatopathy


Whitney Jackson

, MD, University of Colorado School of Medicine

Last full review/revision May 2020| Content last modified May 2020
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Congestive hepatopathy 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 beyond their complaints related to heart failure. 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. Fluid may accumulate in the abdomen—a disorder called 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 tests) and to evaluate blood clotting. The diagnosis is based on symptoms and results of the examination and blood tests. Congestive hepatopathy is important to identify mainly because it indicates how severe heart failure is.

Management focuses on treating the heart failure. Such treatment may restore normal liver function.

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Test your knowledge

Cholestasis is reduction or stoppage of the flow of bile, the digestive fluid produced by the liver. It can be caused by disorders of the liver, bile duct, or pancreas. Which of the following is a key symptom that is almost always present in people with cholestasis? 
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