Congestive liver is liver damage, which is caused by blood backing up in the liver. There are acute and chronic courses of the disease. If left untreated, complete destruction of the liver occurs in the long term.
What is congested liver?
A congested liver is a liver disease caused by a back-up of blood in the liver. A congested liver is a liver disease caused by a backlog of blood in the liver. This backlog disrupts its oxygen supply and causes liver cells to die in the short or long term. The blood back-up is caused by an impaired outflow of venous blood. In most cases, right heart failure is present. However, pulmonary diseases and thrombosis in the hepatic vein are also possible causes. There are three forms of congested liver. Thus, an acute, a subacute and a chronic form can be distinguished. Often there are different reasons for the development of these different forms. However, the acute congested liver can also change into the chronic form in the long term. A striking feature of the congested liver is an enlargement of the organ due to the backlog of blood. Only in the chronic form does the liver appear shrunken, although congestion is also present. The end state of congested liver is usually cirrhosis, which in the case of congested liver is called cirrhosis cardiaque (cardiac cirrhosis).
Cause
The cause of congested liver is always due to venous blood backing up in the liver. However, the occurrence of this backlog may have several causes. In most cases, there is a right heart failure. The heart is no longer able to adequately transport the venous blood to the pulmonary circulation. Venous blood back-up begins in the liver and may involve other organs of the dependent organ system. Thus, congested liver is always a sequela of an underlying disease. Right heart failure, in turn, can have multiple causes. For example, valvular defects, tumors, emboli or chronic lung disease lead to heart failure. Right heart failure refers to the weaker performance of the right ventricle. It is responsible for conveying venous blood to the pulmonary circulation, where it can be replenished with oxygen through gas exchange. Severe chronic lung diseases such as COPD or pulmonary fibrosis increase the resistance of the pulmonary circulation to the venous blood, so that the cardiac output is overtaxed in the long term. Chronic congested liver develops. Pulmonary embolism and sudden occlusion of the hepatic vein by blood clots represent acute emergency events that include the symptom of congested liver. Acute hepatic vein occlusion is also known as Budd-Chiari syndrome. In addition to a sudden development of a blood clot, a tumor pressing on the hepatic vein may also be responsible for hepatic vein occlusion. After the accumulation of blood in the liver tissue, the liver cells surrounding the central veins initially experience reduced blood supply. Saff metabolism is disturbed and fatty degeneration of the hepatocytes begins. If the congestion persists for a prolonged period, necrosis of the affected liver cells begins.
Symptoms, complaints, and signs
Initially, symptoms of congested liver manifest as discrete symptoms of the underlying disease. This is followed by the classic signs of liver failure, which are manifested by the appearance of jaundice (icterus), clotting disorders, and hepatic coma. However, the courses of the disease vary in drama and depend on whether it is the acute, subacute or chronic form of congested liver. If left untreated, congested liver ends in complete destruction of the liver tissue. Acute congested liver shows a dramatic course. Thus, the liver swells very rapidly, with acute liver capsule tension pain. On palpation, the liver is spontaneously very painful. Macroscopically, it appears enlarged with a dark red surface. Small red dots still appear at the same time. In the subacute form, the liver looks enlarged and patchy. This appearance is also known as an autumn leaf pattern. In addition to red spots, white spots also appear. The reddish spots characterize dilated sinusoids (small blood vessels), while the white spots represent fatty liver parenchyma. At this stage, liver necrosis begins.In the chronic form of congested liver, the liver appears reduced in size again, although it should be enlarged according to expectations. However, connective tissue forms in the area of the dead liver tissue. The liver shrinks and hardens. In the process, cirrhosis of the liver develops.
Diagnosis and course of the disease
Ultrasound examinations are performed to diagnose congested liver. A greatly enlarged organ with dilated hepatic veins is found. Whereas the acute congested liver appears more echo-poor than in the normal state, the chronic form of the disease is found to have condensed finely cusped echo structures. Comprehensive laboratory tests of interest include levels of transaminases, gamma-glutamyltransferase (GGT), and various other values. Elevations in these laboratory values indicate disturbances in liver function. The relationship of these laboratory values to each other is of interest for differential diagnosis with other liver diseases.
Complications
A congested liver usually develops as a result of right heart failure (right heart failure), which has several complications. Consequences of untreated right heart failure include cardiac arrhythmias (arrhythmias). In the case of atrial fibrillation, thrombi can easily form in the wall of the atrium, which can then subsequently break loose and be carried further with the bloodstream. In the case of the right heart, the blood clots are carried toward the pulmonary vessels and can cause pulmonary embolism, which is characterized by shortness of breath and crushing chest pain. Ventricular fibrillation, if untreated, quickly leads to circulatory arrest and, as a result, immediate cardiac death. Congestion of blood in the liver causes the organ to enlarge, which can cause pain in the upper right abdomen. In addition, cirrhosis of the liver may develop during the course of the disease. In this, the liver is no longer able to synthesize enough proteins and edema and clotting problems develop, as well as ascites. Blood can also no longer be transported properly through the liver, so it must be redirected to the spleen. The spleen enlarges as a result (splenomegaly) and further pain develops. Other bypassed circuits result in esophageal varices and hemorrhoids. Besides, in liver cirrhosis, detoxification function is no longer guaranteed, and ammonia accumulates more in the blood, which may lead to encephalopathy.
When should you go to the doctor?
Because the liver does not have its own pain receptors, the doctor should already be consulted if there is diffuse pain in the right upper abdomen. In fact, this pain occurs only when the organ is already enlarged. Increasing fatigue and exhaustion can also often be an alarm signal for an acute, subacute or chronic congested liver. Also, if the liver reacts to pressure with a spontaneous pain, the decision to see a doctor is very obvious. Because right-sided heart failure can also lead to congested liver, consultation with an internist or cardiologist should be made directly when heart pain is present. This need is especially true if an arrhythmia (cardiac dysrhythmia) is present. Shortness of breath, in conjunction with cardiac involvement, may indicate that blood clots are being carried to the pulmonary vessels. In that case, medical treatment must be initiated immediately. Anyone who observes yellowing of the skin or mucous membranes should inform their family doctor immediately. If clotting disorders or features of jaundice become apparent over time, a physician should be consulted immediately.
Treatment and therapy
Because congested liver is not a disease in its own right but always the sequela of an underlying disorder, the underlying disease must be treated to cure it. In most cases, this is right heart failure, but the cause remains to be determined. must be noted that drug metabolism may be impaired because of the liver disease. This often requires other treatment strategies in addition to drug therapy. In rare cases, surgical measures such as heart or lung operations may also be targeted.
Outlook and prognosis
A congested liver is already a severe symptom of liver disease, so the prognosis is usually negative. Usually, the underlying disease leads to further symptoms that further stress the liver and eventually lead to organ failure.When a congested liver occurs, treatment of the usually causative cirrhosis is usually no longer possible. However, the inevitable liver failure can be delayed; how long depends on the type and severity of the underlying disease, the patient’s constitution and possible previous diseases. The outlook for liver cirrhosis is determined with the aid of the Child-Pugh criteria, which take into account liver function (blood clotting, bilirubin content, etc.) and possible secondary diseases (ascites, encephalopathy), for example, and on the basis of which an accurate prognosis can be made. The chances of recovery in the case of causative ascites are about 50%, although further inflammation makes a very severe course more likely. The outlook for a congested liver is also worsened by possible complications such as bleeding or the formation of cysts and tumors in the liver. The final prognosis should always be made by a physician.
Prevention
To prevent congested liver, all the recommendations that are also made to prevent cardiovascular and pulmonary diseases apply. A healthy lifestyle with a balanced diet, plenty of exercise, and abstinence from smoking or alcohol, respectively, reduces the risk of congested liver.
Follow-up
In most cases, sufferers of congested liver have only limited measures of direct aftercare available to them, so ideally sufferers should see a doctor at the first signs and symptoms of this disease. There is no independent cure, so a doctor should be consulted at an early stage. As a rule, early diagnosis of this disease always has a very positive effect on the further course. As a rule, in the case of congested liver, the underlying disease must be treated properly so that it does not lead to further complications and discomfort. In many cases, surgical intervention is necessary. Afterwards, the affected person should rest and take it easy in any case. Physical exertion or stressful activities should be avoided in any case, so as not to put unnecessary strain on the body. Regular check-ups by a doctor are also very important after the procedure. In general, a healthy lifestyle with a balanced diet can also have a positive effect on the further course of the disease in the case of a congested liver.
What you can do yourself
Because congested liver is not caused by an independent reason, measures should be taken on the part of the affected person for the general treatment of the underlying disease. The appropriate action steps depend on the specific disease. For the prevention of congested liver, the same recommendations apply as for the prevention of cardiovascular and pulmonary diseases. A healthy lifestyle is recommended for those affected. This includes a healthy and balanced diet. This includes eating a healthy and balanced diet, especially plenty of fresh fruit and vegetables, and avoiding excessive consumption of fast food and convenience products. Plenty of exercise and sufficient sleep can also reduce the risk of congested liver. The consumption of nicotine, alcohol or drugs should be avoided as a preventive measure. In addition, those affected should attend preventive check-ups at regular intervals and consult a doctor immediately if they show the first symptoms. Avoiding stress also has a positive effect. If the patient is exposed to a high degree of stress, relaxation-promoting measures such as long walks, yoga or various meditation techniques are recommended.
