Cardiogenic cirrhosis

Introduction to cardiogenic cirrhosis Cardiogenic cirrhosis is caused by repeated episodes of chronic congestive heart failure. Long-term congestion and hypoxia, resulting in liver reticular fibrous tissue hyperplasia, mainly in the center of the hepatic lobules showing astral fibrosis, fibrous tissue segmentation of the hepatic lobules into irregular cell clusters, that is, the formation of false leaflets. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, hepatic encephalopathy, ascites

Cause of cardiogenic cirrhosis

Any disease that causes the blood in the inferior vena cava to be blocked can cause liver congestion, such as rheumatic valvular heart disease, chronic constrictive pericarditis, hypertensive heart disease, ischemic heart disease, pulmonary heart disease, congenital heart disease. Wait.

Rheumatic heart valve disease is the first in cardiogenic cirrhosis, rheumatoid heart valve disease is about 4% to 12% with cardiogenic cirrhosis, cardiogenic cirrhosis is 53.2% caused by rheumatic heart valve disease, rheumatic heart valve When the disease causes congestive heart failure, the right atrium and right ventricle pressure increase, affecting hepatic venous blood return and causing liver congestion and cirrhosis.

In chronic constrictive pericarditis, the hypertrophic pericardium compresses the heart, which greatly limits the diastolic filling of the heart, resulting in increased right ventricular end-diastolic pressure and right atrial pressure, resulting in obstruction of hepatic venous blood flow, continuous increase in hepatic venous pressure, liver Central hepatic sinus dilatation, congestion, hemorrhage, resulting in hypoxia and necrosis of hepatocytes, central reticular fibrous tissue hyperplasia, leading to cardiogenic cirrhosis.

Hypertensive, coronary atherosclerosis, pulmonary origin, congenital heart disease and other right heart failure, can also cause hepatic venous blood flow blocked, liver congestion and liver cirrhosis.

The naked eye can be seen with enlarged liver, purple, and blunt edge. The liver tends to become smaller after the patient's death or autopsy. The cut surface can be in the form of musk nutmeg, which is red and white. The red area is the hemorrhage area, which is located around the portal vein. There was no absolute correlation between the severity of congestive heart failure and the degree of hepatic lobular necrosis.

Congestive liver injury initially involves the central area of the lobule, central venous congestion, expansion, and the degree of hepatic sinus expansion is different from that of the central venous sinus. The central hepatocytes of the lobule are compressed, deformed and atrophied, and the cytoplasm is present. Particle-like changes, nucleus pyknosis, nuclear fission, cell necrosis, accompanied by brown pigmentation, brown pigment in the center of the lobules, may be caused by cholestatic, liver necrosis and necrosis adjacent to the central vein is the most serious, with the increase of congestion, necrosis The tissue extends to the portal area. Patients with severe congestion have normal liver tissue only in the portal area. Over time, the reticular fibers around the central vein can collapse. It can be seen that the reticular fibrous tissue and the fine fiber bundle extend from the central vein to the other. The central vein, the fibrous bridge-like connection between the central veins of adjacent lobes is a characteristic of cardiogenic cirrhosis. Because patients die of cardiovascular disease, it is rare for the liver to develop into a large area of extensive regenerative nodules.

Cardiogenic cirrhosis prevention

Mainly to prevent myocarditis, prevention and treatment of cardiovascular diseases such as hypertension.

Complications of cardiogenic cirrhosis Complications upper gastrointestinal bleeding hepatic encephalopathy ascites

Easy to have electrolyte imbalance, upper gastrointestinal bleeding, ascites, hepatic encephalopathy, etc.

Cardiac cirrhosis symptoms common symptoms fatigue jaundice hepatomegaly abdominal distension jugular vein splenomegaly portal hypertension upper abdominal discomfort ascites spider mites

Patients with congestive heart failure and passive liver congestion are mostly symptoms and signs caused by severe heart failure, while liver involvement is secondary, with mild right upper abdominal discomfort, 10% to 20% with jaundice, physical examination. Can have congestive heart failure, including jugular vein engorgement, positive for jugular jugular venous return, most patients with hepatomegaly, a few can be highly enlarged, 50% of patients under the costal margin more than 5cm, with a secondary tricuspid valve Patients with incomplete closure can reach the expansive liver pulsation. With the formation of liver fibrosis, the liver can be retracted to normal, 15% of patients have ascites, and 25% have splenomegaly.

Cardiac cirrhosis

Laboratory inspection

There was no absolute correlation between hepatic congestion and abnormal liver function, 80% had sulfonate retention, 25% to 75% had elevated serum bilirubin, and serum alkaline phosphatase was mostly normal or only slightly elevated. Most other liver diseases are accompanied by an increase in serum alkaline phosphatase, which can also distinguish between congestive liver disease and other liver diseases. In acute congested liver, serum transaminase (AST, ALT) is significantly increased, while chronic congestion There is only a slight increase in liver, whether it is acute or chronic hepatic congestion, accompanied by albumin reduction and globulin elevation, prolonged prothrombin time, the latter can not be corrected with vitamin K, and gradually with the improvement of congestive heart failure Return to normal, in addition, with congestive heart failure improved, other liver function indicators, especially serum transaminase, will soon return to normal, and sulfonate retention test can be restored after 1 to 2 weeks, low prothrombin blood The disease can only be recovered after a few weeks.

Biochemical indicators are difficult to distinguish between cirrhosis and non-cirrhosis. Cardiac cirrhosis has few abnormal biochemical indicators. It may have died of cardiovascular disease before the patient progressed to cardiogenic cirrhosis. Situation should consider the formation of cardiogenic cirrhosis:

1 severe rheumatic heart disease, especially mitral stenosis;

2 chronic constrictive pericarditis;

3 severe congestive heart failure recurrent or long-term existence;

4 severe hepatic congestion, but the liver is not large, ascites and splenomegaly; 5 tricuspid regurgitation, but the liver failed to reach the corresponding expansion pulsation.

Liver biopsy

Is the diagnosis of indicators, but the hepatic venous pressure increases in congestive heart failure, so liver wear is easy to cause bleeding, need to correct heart failure, liver function can be corrected after liver biopsy, but if the need for puncture to confirm the diagnosis, in prothrombin Liver biopsy is also feasible when time and platelet indicators are permitted.

Diagnosis and diagnosis of cardiogenic cirrhosis

diagnosis

1 severe congestive heart failure patients with passive liver congestion, large liver, tenderness.

2 serum cholic acid and transaminase increased slightly, prothrombin time prolonged, serum alkaline phosphatase did not change significantly.

3 With the improvement of congestive heart failure, liver function test is rapidly improved, and 4 liver biopsy tissue examination can help to confirm the diagnosis.

Differential diagnosis

Identification with other nutritional cirrhosis, primary cirrhosis.

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