Congestive Hepatopathy

Most patients are asymptomatic. However, moderate congestion causes right upper quadrant discomfort (due to stretching of the liver capsule) and tender hepatomegaly. Severe congestion leads to massive hepatomegaly and jaundice Jaundice Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL (34 to 51 micromol/L)... read more . Ascites Ascites Ascites is free fluid in the peritoneal cavity. The most common cause is portal hypertension. Symptoms usually result from abdominal distention. Diagnosis is based on physical examination and... read more may result from the transmitted central venous hypertension; infrequently, splenomegaly results. With transmitted central venous hypertension, the hepatojugular reflex is present, unlike in hepatic congestion due to Budd-Chiari syndrome Budd-Chiari Syndrome Budd-Chiari syndrome is obstruction of hepatic venous outflow that originates anywhere from the small hepatic veins inside the liver to the inferior vena cava and right atrium. Manifestations... read more .

Congestive hepatopathy is suspected in patients who have right-sided heart failure, jaundice, and tender hepatomegaly. Laboratory test results are modestly abnormal: unconjugated hyperbilirubinemia (total bilirubin < 3 mg/dL [51.31 micromol/L]), elevated (usually < 2- to 3-fold) aminotransferases, and prolonged prothrombin time/international normalized ratio (PT/INR). Ascitic fluid, if present, is characterized by a high serum-to-ascites albumin concentration gradient (the serum albumin concentration minus the ascitic albumin concentration [SAAG]). Gradients ≥ 1.1 g/dL (11 g/L) are relatively specific for ascites Ascites Ascites is free fluid in the peritoneal cavity. The most common cause is portal hypertension. Symptoms usually result from abdominal distention. Diagnosis is based on physical examination and... read more due to portal hypertension (1 Diagnosis references Congestive hepatopathy is diffuse venous congestion within the liver that results from right-sided heart failure (usually due to a cardiomyopathy, tricuspid regurgitation, mitral insufficiency... read more ). In addition, a high ascitic total protein content (typically> 2.5 g/dL [25 g/L]) plus a SAAG ≥ 1.1 g/dL (11 g/L) suggests congestive hepatopathy (2 Diagnosis references Congestive hepatopathy is diffuse venous congestion within the liver that results from right-sided heart failure (usually due to a cardiomyopathy, tricuspid regurgitation, mitral insufficiency... read more ) and differentiates portal hypertension Diagnosis references Congestive hepatopathy is diffuse venous congestion within the liver that results from right-sided heart failure (usually due to a cardiomyopathy, tricuspid regurgitation, mitral insufficiency... read more from cirrhosis Cirrhosis Cirrhosis is a late stage of hepatic fibrosis that has resulted in widespread distortion of normal hepatic architecture. Cirrhosis is characterized by regenerative nodules surrounded by dense... read more (typically total protein < 2.5 g/dL [25 g/L] plus a SAAG ≥ 1.1 g/dL [11 g/L]).

Because the laboratory abnormalities are nonspecific, recognition of congestive hepatopathy is ultimately clinical. The liver disorder is more important as an index of the severity of heart failure than as a diagnosis by itself.

Treatment is directed at the underlying heart failure.