Diagnosis of a congested liver
The diagnosis of a congested liver can be made relatively easily. On the one hand, the medical history includes the typical symptoms of right heart failure and liver dysfunction (see below). A congestion of the neck veins is also usually visible in the physical examination; in advanced stages of the disease, signs of cirrhosis can also be detected, such as water in the abdomen (ascites).
In the laboratory chemical examination, an increase in liver values as well as an increased pro-BNP as a marker for heart failure is shown.An ultrasound examination of the liver confirms the suspicion; here the congestion of the liver veins can be clearly seen. Furthermore, an ultrasound examination of the heart should also be performed to assess the pumping function of the right heart. Sonography (ultrasound) of the liver is a good method to diagnose a congested liver.
The congested liver veins are clearly dilated, which can be seen in the hepatic vein windows as well as in the surrounding area. The inferior vena cava is also clearly widened. Breathing modulation is suspended, i.e. the diameter of the blood vessels no longer changes with inhalation and exhalation.
The blood vessels are always maximally dilated by the high filling pressure. The tissue of the liver itself can also be assessed well in sonography. Depending on the severity of the damage, a typical image is obtained in sonography.
An MRI of the liver in cases of congested liver is actually rarely necessary. In most cases, a clear diagnosis can be made by means of sonography. If, on the other hand, the right heart is pumping normally and if the cause of the congested liver is suspected to be an occlusion of the liver veins due to thrombosis (Budd-Chiari syndrome), then an MRI of the liver may well be useful.
In this way, the liver veins can be depicted in their further course and thrombotic occlusion of the vessels can be detected. In the case of a regular congested liver in the context of right heart failure, an MRI examination of the liver is not necessary. Typical for a congested liver is always an increase in liver values, especially of the transaminases.
If the increase in transaminases is caused by congestion, the GOT is usually higher than the GPT. Often, the values are only discreetly elevated, but they can also rise up to the thousands. With increasing liver dysfunction, an increase in bilirubin is also seen.
The Quick value drops. The ammonia level in the blood may be elevated. A marker for heart failure is the pro-BNP, this can also be measured in the blood. In right heart failure it would be elevated.
