HealthDiseases and Conditions

Muscat liver: anatomy, histology, pathomorphology

Muscat liver is a consequence of chronic congestive venous congestion of internal organs. This condition is reflected not only in the digestive system, but also in the heart, lungs, kidneys and brain.

Classification

Morphologically, three stages of changes occur in the liver as the disease progresses:

  1. Muscat liver: on the background of fat cell degeneration (yellow color), there are enlarged vessels (dark red color).
  2. Stagnant fibrosis: the tissue is more dense because of the germination of the connective tissue. Blood infiltrates the parenchyma of the body, as well as lesions of sclerosis.
  3. Heart cirrhosis: the surface of the organ becomes a tuberous appearance.

Etiology

Violation of the outflow of blood from the portal vein system leads to the formation of a phenomenon such as muscat liver. The causes of stagnation are a violation of the function of the ventricles of the heart and a decrease in venous return. These are manifestations of heart failure, and often they accompany ischemic heart disease. Increased pressure in the venous system, as well as congestion and stagnation of blood in the vessels interfere with effective blood flow in the organs.

Epidemiology

The disease is not related to sex or age. But statistically, the most frequently affected men are senile and elderly. Most often, only at the autopsy you can determine that the patient had a nutmeg liver. Patanatomy can provide answers to questions that are of interest to the attending physician. For this purpose, the organs are not only visually evaluated, but also sent for histological examination.

Risk factors for the development of liver pathology include inactivity, malnutrition, bad habits, the presence of a history of heart disease, and the elderly age of a person.

Clinic

In most cases, the symptoms of heart failure prevail in the clinical picture of the disease, so the patient may not suspect that he has liver problems. Muscat liver, like any other cirrhosis, is manifested by pain in the right upper quadrant, jaundice of the skin and mucous membranes, edema on the legs at the end of the day, ascites (accumulation of fluid in the abdominal cavity). But these are all indirect signs. To make a 100% diagnosis is possible only after the opening, because none of the modern ways of visualization can show whether the organ reminds of nutmeg. The liver will be dense on palpation, its edge is rounded and protrudes from beneath the costal arch.

Diagnostics

In order to diagnose "chronic passive venous plethora", it is necessary:

1. Confirm the presence of heart failure (instrumental or physical examination):

  • Chest X-ray of the chest (indicates a change in the heart, venous congestion in the lungs or the presence of effusion);
  • Doppler study of the heart and inferior vena cava (to identify the causes of heart disease);
  • CT or MRI;
  • ECG.

2. Conduct laboratory tests, such as a biochemical blood test and liver tests :

  • Bilirubin in the blood rises;
  • Moderately increased transaminases (ALT, AST);
  • Increase in alkaline phosphatase;
  • Decrease in albumin and lengthening of clotting time.

3. To resort to instrumental diagnostics to morphologically establish the fact of liver degeneration. Such studies include:

  • Laparocentesis (aspirating free fluid from the abdominal cavity) to establish the causes of ascites;
  • Puncture biopsy (to confirm the diagnosis of "Muscat liver" micropreparation can be made and during the life of the patient).

Comparative diagnosis is carried out with such diseases as alcoholic cirrhosis, oncological heart disease, hemochromatosis, thrombosis of the inferior vena cava and portal hypertension. Do not forget about viral diseases of the liver - hepatitis A, B, C, D, E. In addition, there is a possibility of parasitic disease.

Complications

Muscat liver and cardiac cirrhosis causing it does not affect the outcome of heart failure. Cases when acute liver failure caused death are rare and can not be considered indicative. Blood clotting disorders are also quite rare, although not unprecedented. Some experts suspect that there is a link between cirrhosis of the liver and the appearance of malignant neoplasms, but this theory has not yet been proved.

Treatment

Medication therapy should be aimed at eliminating the underlying disease, that is, heart failure. And cirrhosis itself does not have specific therapy. In addition, the patient is recommended to follow a diet with limited salt salt and change the routine of your day to get plenty of sleep, to be outdoors and get enough exercise. These simple manipulations will help to lower arterial pressure in the main vessels, including in the portal vein.

Symptomatic therapy consists of taking diuretics (to reduce the amount of fluid in the abdominal cavity), as well as beta-blockers and ACE inhibitors (for normalization of the heart).

Surgical treatment, as a rule, is not carried out. This involves a great risk for the patient and does not justify itself. Sometimes a doctor may decide to bypass the intrahepatic part of the portal vein, but this can lead to serious heart failure in the right ventricular type and pulmonary edema due to a sharply increased venous return.

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