Nutmeg liver


Nutmeg liver

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Nutmeg liver is the pathological appearance of the liver caused by chronic passive congestion of the liver secondary to right heart failure. The liver appears "speckled" like a grated nutmeg kernel, from the dilated, congested central veins (dark spots) and paler, unaffected surrounding liver tissue. When severe and longstanding, hepatic congestion can lead to cirrhosis, a state described as cardiac cirrhosis. [cite journal |author=Giallourakis CC, Rosenberg PM, Friedman LS |title=The liver in heart failure |journal=Clin Liver Dis |volume=6 |issue=4 |pages=947–67, viii-ix |year=2002 |pmid=12516201 |doi=10.1016/S1089-3261(02)00056-9]

Etiology

Increased pressure in the sublobular branches of the hepatic veins causes an engorgement of venous blood, and is most frequently due to chronic cardiac lesions, especially those affecting the right heart, the blood being dammed back in the inferior vena cava and hepatic veins. Central regions of the hepatic lobles are red/brown and stand out against the non-congested tan coloured liver. Centrilobular necrosis occurs. Macroscopically liver has a pale and spotty appearance in affected areas as stasis of the blood causes pericentral hepatocytes (liver cells surrounding the periportal venules of the liver) to become deoxygenated compared to the relatively better oxygenated periportal hepatocytes adjacent to the hepatic arterioles. This retardation of the blood also occurs in pulmonary lesions, such as chronic interstitial pneumonia, pleural effusions, and intrathoracic tumors.

Symptoms

These depend largely upon the primary lesions giving rise to it. In addition to the cardiac or pulmonary symptoms, there will be a sense of fullness and tenderness in the right hypochondriac region. Gastro-intestinal catarrh is usually present, and hematemesis may occur. There is usually more or less jaundice. Owing to portal obstruction, ascites occurs, followed later by general dropsy. The stools are light or clay colored, and the urine is colored by bile. On palpation, the liver is found enlarged and tender, sometimes extending several inches below the costal margin of the ribs.

Treatment

This is directed largely to removing the cause, or, where that is impossible, to modifying its effects. Thus hygienic and dietary measures must be carried out, even although it is due to valvular lesions.

ee also

* Ischemic hepatitis

References


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Look at other dictionaries:

  • Nutmeg liver — Nutmeg Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native… …   The Collaborative International Dictionary of English

  • nutmeg liver — n a liver appearing mottled like a nutmeg when cut because of congestion and associated with impaired circulation esp. from heart or lung disease * * * a liver that has a mottled appearance when cut, as a result of chronic passive congestion (see …   Medical dictionary

  • nutmeg liver — noun : a liver appearing mottled like a nutmeg when cut because of congestion and associated with impaired circulation especially from heart or lung disease …   Useful english dictionary

  • Nutmeg — Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native of the… …   The Collaborative International Dictionary of English

  • Nutmeg bird — Nutmeg Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native… …   The Collaborative International Dictionary of English

  • Nutmeg butter — Nutmeg Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native… …   The Collaborative International Dictionary of English

  • Nutmeg flower — Nutmeg Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native… …   The Collaborative International Dictionary of English

  • Nutmeg melon — Nutmeg Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native… …   The Collaborative International Dictionary of English

  • Nutmeg pigeon — Nutmeg Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native… …   The Collaborative International Dictionary of English

  • Nutmeg wood — Nutmeg Nut meg, n. [OE. notemuge; note nut + OF. muge musk, of the same origin as E. musk; cf. OF. noix muguette nutmeg, F. noix muscade. See {Nut}, and {Musk}.] (Bot.) The kernel of the fruit of the nutmeg tree ({Myristica fragrans}), a native… …   The Collaborative International Dictionary of English