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Published 18.04.2016 | Author : admin | Category : How Can I Make Money

Lon standing severe right hart failure leads to elevated central venous pressure which spreads directly to the liver via the inferior vena cava and hepatic veins. Right heart failure in the presence of left heart failure there is severe central hypoxia producing necrosis around the central areas with seinusoidal congestion. Cardiac cirrhosis is the appearance the liver takes in response to chronic passive congestion secondary to right heart failure.
Centrilobular necrosis- the central portion of the hepatic lobule is the last to receive blood and necrosis can occur due to reduced or insufficient blood flow. Cardiac Cirrhosis (nutmeg liver) is due to long standing severe right-sided congestive heart failure. It is a disease characterized by inadequate coronary perfusion relative to the myocardial demand. Cause by progressive narrowing of the artery by an enlarging atheroma- will cause cardiac hypertrophy. Latest on Medchrome AnswersAnswered: After giving entrance in iom and ku, do we have to give entrance exam again in tu or ku affiliated colleges?They say Lowkal sugar stevia in India is very harmful and poisonous.
The disease process underlying most ischemic heart disease is atherosclerosis of the coronary arteries. Microscopically, there is evidence of centrilobular necrosis with loss of hepatocytes dropout and hemorrhage, including hemosiderin-laden macrophages. The venous congestion in the liver blocks drainage of the sinusoidal blood flow into terminal hepatic venules which will cause atrophy and fibrosis around the central areas.

The Nutmeg liver is also seen due to chronic passive congestion of the liver which is secondary to RHF. Chronic Ischemic Heart Disease- Is a condition where there is a reduced blood supply to the heart, which eventually will turn into a complete obstruction of the heart. Cardiac cirrhosis also called nutmeg liver is where hepatic lobules are red-brown and slightly depressed  and are against the surrounding zones of uncongested tan liver. Occurs when left-sided heart failure and right-sided heart failure are both present and severe central hypoxia produces such a necrosis along with sinusoidal congestion. Please see the image ( attached)to understand the Centrilobular necrosis and Cardiac cirrhosis. Content (text, audio, video) on this website is only intended to provide general information to the reader and for academic purpose of medical students. In severe, long-standing hepatic congestion (most commonly associated with heart failure), there may even be grossly evident hepatic fibrosis (cardiac cirrhosis).
Venous congestion impeds efficient drainage of the sinusoidal blood flow into the terminal hepatic venules.
THe central lobules of the liver are red and or brown as they are engorged by the hepatic vein from the backed up IVC and hence stand out against the non-congested part of the liver which appears tan. Coronary heart disease risk increases with age, smoking, hypercholesterolaemia (high cholesterol levels), diabetes, hypertension (high blood pressure) and is more common in men and those who have close relatives with ischaemic heart disease. Eventually, the liver becomes engorged and swollen with blood for a prolonged period of time.

Once the atheroma is present and occlusions are formed a patient may present with various forms of angina. This leads to chronic liver injury and inflammation and the formation of scar tissue in the liver (fibrosis). Therefore with the accumulation of the deoxygenated blood there is necrosis which is followed by deposition of collagen and then finally, fibrosis.
If the occlusion is less than 75%, it is stable angina where pain is only felt upon stress.
Once the occlusion or atheromatous plaque exceeds 75%, therefore the plaque changes, but does not reach 100% occlusion, it is considered Unstable Angina.
This 100% occlusion in an MI can be reached by one of three categories: 1) rupture of a plaque where the clot ruptures, ulcerates, hemorrhages and then erodes. 2)Prolonged coronary artery spasms which may be effected by smoking or using street drugs such as cocaine or 3) Emboli from some other pathophysiological problem such as vegetative endocarditis or a paradoxical embolism usually occuring due to a VSD or ASD.
Overall ischemic heart disease manifests its way from the beginning of the atheroma into either angina, MI, cardiac death or will prolong to produce chronic ischemic heart disease.

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