Epidemiology
Etiology
- Cardiac cirrhosis
- A complication of right-sided heart failure characterized by cirrhosis due to chronic hepatic vein congestion.
- Associated with “nutmeg liver” (diffuse mottling on imaging due to ischemia and fatty degeneration).
Pathophysiology
- Cytokine‑mediated activation of hepatic stellate cells has been identified as a central element for developing fibrosis.
- A cell found in the perisinusoidal space of the liver
- Quiescent phase: vitamin A storage
- Activated phase: transform into myofibroblast to secrete collagen (primary cell involved in hepatic fibrosis)
Clinical features
Diagnostics
CT abdomen
- Relative hypertrophy of the left lobe and caudate lobe
- Regenerative nodules
- Irregular liver surface
- Indirect findings: ascites, splenomegaly, portosystemic collaterals
Pathology
- Fibrosis (fibrous septa)
- Replacement of normal liver tissue with collagenous regenerative nodules
Treatment
Complications
Portal hypertension
- Portal vein collateral circulation
- Portal vein → Left gastric vein → Esophageal venous plexus → Azygos vein → Superior vena cava
- Portal vein → Inferior mesenteric vein → Rectal venous plexus → Internal iliac vein → Inferior vena cava
- Portal vein → Paraumbilical vein → Periumbilical venous network → Abdominal wall vein → Superior and inferior vena cava