Definition
In a congested liver, the blood backs up in the liver because it can no longer drain through the liver veins. The cause of a congested liver is a weak right heart (heart failure). The heart can no longer pump blood from the liver to the lungs.
The blood backs up into the liver. This changes the liver tissue significantly. The liver cells die and liver cirrhosis develops, which can lead to liver failure.
Causes of congested liver
A congested liver is a serious threatening disease. However, the cause of the development of a congested liver is usually not in the liver, but in the heart, more precisely in the right half of the heart. This is where the blood should actually be pumped from the body (including the liver, but also from the vena cava) into the pulmonary circulation.
With right heart failure, the blood looks back into the organs. This also happens when the liver veins are blocked by thromboses (Budd-Chiari syndrome). Due to the constant pressure of the blood column, the tissue changes.
In the course of the disease, the congested liver then develops into cirrhosis of the liver. The cause of a congested liver is a weakness of the right heart. This is also called right heart failure in medical terminology.
Right heart failure can have many causes. It can develop, for example, in lung disease. The right heart must always pump against the increased pressure in the pulmonary circulation (pulmonary hypertension) and gets tired.
This is also the case with heart valve disease such as a narrowing of the pulmonary valve. However, right heart failure can also be present together with left heart failure, in which case the heart muscle weakness is usually the result of various heart attacks or myocarditis. The consequences are always the same; the lack of pumping power of the heart causes the blood to congest the organs, including the liver.
What are the symptoms of congested liver?
In the early stages of a congested liver, the symptoms are relatively unspecific. Those affected complain of fatigue, exhaustion and a general feeling of illness. If the disease progresses further, the typical symptoms of a liver dysfunction with jaundice (icterus), protein deficiency, blood clotting disorders and, in the final stage, hepatic coma (hepatic encephalopathy) develop.
Right heart failure also causes problems for the patients, the water accumulates not only in the liver but also in the upper and lower vena cava. The consequences are swollen neck veins and very pronounced leg edemas. This is naturally accompanied by a general reduction in performance.
Pain is not necessarily one of the typical symptoms of a congested liver. However, it is possible that capsule stretching may occur. The liver capsule is very sensitive to pain.
Due to the pressure of the venous blood congestion, which cannot be pumped further, it is possible that the liver will initially swell. This increases the volume of the liver and the tissue presses on the liver capsule that surrounds it. This can be quite painful.
Sometimes this is also noticed during the physical examination. A palpation of the liver leads to a painful jerking in the patient. Water in the abdomen or ascites, as it is called in medical terminology, is a known complication of liver disease.
It manifests itself through a balloon-like distended abdomen. It develops in congested liver when the disease has progressed so far that cirrhosis of the liver is present. Cirrhosis of the liver results in a connective tissue remodelling of the liver.
The blood from the portal vein can no longer flow so well through the liver because the connective tissue prevents the blood flow. Therefore, the blood accumulates in front of the liver back into the abdomen (= portal hypertension). Abdominal fluid is therefore always a sign that cirrhosis of the liver must already be present.