Cirrhosis of the liver as a consequence of heart failure. Congested liver in heart failure

With stagnation in the systemic circulation, the liver usually a short time able to take a significant amount of blood. Its role in infancy and childhood is of paramount importance. A congestive liver is always a sign of insufficiency of the right half of the heart, even if the depletion of the right half of the heart is not primary, but is secondary to the insufficiency of the left half of the heart. Pathological changes and functional disorders occur under the influence of the combined action of increased venous pressure and hypoxia.

At autopsy, the liver is found to be larger, heavier, and denser than normal. With fresh stagnation, its color is red, with older stagnation, it is bluish-brownish-red. With prolonged stagnation, the hepatic capsule thickens. Due to secondary fatty degeneration, the liver may have yellowish spots. With a short-term stagnation, the pattern on the section is pronounced, in the center of the lobules the central veins gape redly and at the edges of the hepatic balustrades - capillaries. The color of the liver bumps is very pale compared to the red spots of the gaping vessels. After a long existing stagnation, the liver cells at the edges of the lobules undergo fatty degeneration and therefore acquire a yellowish color, and in the center of the lobule there is a central vein filled with bluish-red blood (“nutmeg liver”). With a long-term stagnation, the pattern of the hepatic lobules is erased, and the connective tissue that takes the place of the dead hepatic substance leads to the appearance of "false lobulation". In the center of these false lobules, there is a yellow hepatic tissue that has undergone fatty degeneration, and gaping-looking vessels are distributed along the edges. With a sudden onset of stagnation in the hepatic substance and under the capsule, many hemorrhages are seen. The microscopic picture is characterized by dilated central veins and capillaries, squeezed between them by hepatic cells with fatty drops and with pigment grains. In the center of the lobules, liver cells often die. Microscopic hemorrhages are common.

With a sudden onset of stagnation in the liver, the patient usually feels a sharp pain in the area of ​​\u200b\u200bthe liver, which may resemble pain caused by gallstone. Often confused with pleurisy. The pain is caused by a sudden pull on the hepatic capsule. Muscular protection may exist over the liver area. A congested liver also affects the function digestive tract: it is accompanied by vomiting, nausea, flatulence, diarrhea and lack of appetite.

IN infancy with acute infectious diseases sometimes it is difficult to decide whether a sudden enlargement of the liver is a consequence of heart failure or toxic damage. In such cases, you can navigate on the basis of other symptoms (increased venous pressure, tachycardia, ECG, etc.). It should be noted here that although the basis of congestive liver is venous congestion However, a pronounced congestive liver without an increase in venous pressure can still occur. The veins, due to their great ability to expand, are sometimes able to balance over time high blood pressure, and by the time the increase in venous pressure becomes measurable, congestive liver has long been established.

IN childhood recognition and elucidation of congestive liver is already easier. The lower edge of the liver goes beyond the costal arch, percussion can also establish an increase in the liver upwards. She lifts right side diaphragm and can compress the lower parts of the lungs. In such cases, the percussion sound above the diaphragm is shortened, and one can hear bronchial breathing. On palpation, a liver is usually evenly compacted with smooth surface, hard, sharp or rounded edge. It rarely pulsates. In childhood, even with insufficiency of the tricuspid valves, it is very difficult to recognize the pulsation of the liver, because the liver tissue is very elastic and the great ability to receive blood equalizes the tense action of the blood flowing back. In chronic decompensation, growth connective tissue makes the liver so hard that it is no longer possible to reckon with its pulsation. With cardiac pseudocirrhosis, the size of the liver, despite stagnation, may be less than normal.

The functional disorder of the liver with a small stagnation is insignificant, however, with a larger or long-term stagnation, it is still significant. A functional disorder must also be considered if it is not detected by functional liver tests, because, based on the literature data and our own experience we believe that functional tests in some cases do not reflect changes in the liver. The content of urobilinogen in the urine increases. Some authors attribute the relationship between the severity of hepatic congestion and the content of urobilinogen in the urine diagnostic value. According to other authors positive result Ehrlich reaction is caused not by urobilinogen, but by stercobilinogen. A significant increase in the concentration of lactic acid in the blood is due to a disorder hepatic function. The content of bilirubin in serum increases significantly only after severe or prolonged stagnation. The patient in such cases has a slight jaundice. The reason for this phenomenon is not fully understood. It is assumed that in the cause of this icterus, liver damage, which occurs in connection with hypoxia, and hemolysis play a role. In favor of the latter is the observation of Magyar and Thoth: an increase in the content of bilirubin in the urine. Jaundice develops slowly and also slowly disappears. In feces, the amount of coloring substances formed from the bile pigment increases.

A disorder of the hepatic function is, with its long existence, one and, possibly, the main reason hypoproteinemia accompanying insufficiency of the right half of the heart. The decrease in the content of proteins in the serum of heart patients is partly due to malnutrition, poor absorption conditions, loss of protein with edematous fluid, but, undoubtedly, a decrease in the ability of the liver to form proteins plays a leading role. Due to hypoproteinemia, drug pumping out of edema is often ineffective for a long time after the restoration of the strength of the heart.

With scarring of the pericardium or with prolonged decompensation, so-called cardiac cirrhosis often occurs. With abundant growth of connective tissue, it is characterized by the death of the liver substance and in places islets of regenerating liver cells. The proliferation of connective tissue takes place not only around the lobules, but also in their central part. If the proliferation of connective tissue merges, then the pattern of the liver substance becomes unrecognizable. With prolonged stagnation, the capsule thickens due to perihepatitis. For the occurrence of cirrhosis of the liver, it is characteristic that the liver becomes hard, small, with sharp edges, its size is fixed. At the same time, due to portal hypertension, the spleen also begins to swell. It becomes bigger and more solid. In this condition, under the influence of treatment acting on the heart and circulation, neither the magnitude nor functional disorder the liver does not change. Cardiac cirrhosis is usually accompanied by ascites that is not amenable to medical treatment.

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congested liver

With stagnation in the systemic circulation, the liver is usually able to take a significant amount of blood in a short time. Its role in infancy and childhood is of paramount importance. A congestive liver is always a sign of insufficiency of the right half of the heart, even if the depletion of the right half of the heart is not primary, but is secondary to the insufficiency of the left half of the heart. Pathological changes and functional disorders occur under the influence of the combined action of increased venous pressure and hypoxia.

At autopsy, the liver is found to be larger, heavier, and denser than normal. With fresh stagnation, its color is red, with older stagnation, it is bluish-brownish-red. With prolonged stagnation, the hepatic capsule thickens. Due to secondary fatty degeneration, the liver may have yellowish spots. With a short-term stagnation, the pattern on the cut is pronounced, in the center of the lobules, the central veins gape redly and at the edges of the hepatic balustrae - capillaries. The color of the liver bumps is very pale compared to the red spots of the gaping vessels. After a long existing stagnation, the liver cells at the edges of the lobules undergo fatty degeneration and therefore acquire a yellowish color, and in the center of the lobule there is a central vein filled with bluish-red blood (“nutmeg liver”). With a long-term stagnation, the pattern of the hepatic lobules is erased, and the connective tissue that takes the place of the dead hepatic substance leads to the appearance of "false lobulation". In the center of these false lobules, there is a yellow hepatic tissue that has undergone fatty degeneration, and gaping-looking vessels are distributed along the edges. With a sudden onset of stagnation in the hepatic substance and under the capsule, many hemorrhages are seen. The microscopic picture is characterized by dilated central veins and capillaries, squeezed between them by hepatic cells with fatty drops and with pigment grains. In the center of the lobules, liver cells often die. Microscopic hemorrhages are common.

With a sudden onset of stagnation in the liver, the patient usually feels a sharp pain in the area of ​​\u200b\u200bthe liver, which may resemble pain caused by a gallstone. Often confused with pleurisy. The pain is caused by a sudden pull on the hepatic capsule. Muscular protection may exist over the liver area. Congested liver also affects the function of the digestive tract: it is accompanied by vomiting, nausea, flatulence, diarrhea and lack of appetite.

In infancy with acute infectious diseases, it is sometimes difficult to decide whether the sudden enlargement of the liver is a consequence of heart failure or toxic damage. In such cases, you can navigate on the basis of other symptoms (increased venous pressure, tachycardia, ECG, etc.). It should be noted here that, although the basis of congestive liver is venous congestion, there may still be a pronounced congestive liver without an increase in venous pressure. The veins, because of their great ability to expand, are sometimes able to balance the increased pressure over time, and by the time the increase in venous pressure becomes measurable, the congested liver has long been established.

In childhood, the identification and clarification of congestive liver is already easier. The lower edge of the liver goes beyond the costal arch, percussion can also establish an increase in the liver upwards. It lifts the right side of the diaphragm and can compress the lower parts of the lungs. In such cases, the percussion sound above the diaphragm is shortened, and bronchial breathing is heard. On palpation, a liver is usually evenly compacted with a smooth surface, a hard, sharp or rounded edge. It rarely pulsates. In childhood, even with insufficiency of the tricuspid valves, it is very difficult to recognize the pulsation of the liver, because the liver tissue is very elastic and the great ability to receive blood equalizes the tense action of the blood flowing back. In chronic decompensation, the proliferation of connective tissue makes the liver so hard that it is no longer possible to reckon with its pulsation. With cardiac pseudocirrhosis, the size of the liver, despite stagnation, may be less than normal.

The functional disorder of the liver with a small stagnation is insignificant, however, with a larger or long-term stagnation, it is still significant. A functional disorder must also be considered if it is not detected by liver function tests, because on the basis of literature data and our own experience, we believe that functional tests in some cases do not reflect liver changes. The content of urobilinogen in the urine increases. Some authors attach diagnostic value to the ratio between the severity of hepatic congestion and the content of urobilinogen in the urine. According to other authors, a positive result of the Ehrlich reaction is caused not by urobilinogen, but by stercobilinogen. A significant increase in the concentration of lactic acid in the blood is due to a disorder of the liver function. The content of bilirubin in serum increases significantly only after severe or prolonged stagnation. The patient in such cases has a slight jaundice. The reason for this phenomenon is not fully understood. It is assumed that in the cause of this icterus, liver damage, which occurs in connection with hypoxia, and hemolysis play a role. In favor of the latter is the observation of Magyar and Thoth: an increase in the content of bilirubin in the urine. Jaundice develops slowly and also slowly disappears. In feces, the amount of coloring substances formed from the bile pigment increases.

A disorder of hepatic function is, with its long existence, one and, perhaps, the most important cause of hypoproteinemia accompanying insufficiency of the right half of the heart. The decrease in the content of proteins in the serum of heart patients is partly due to malnutrition, poor absorption conditions, loss of protein with edematous fluid, but, undoubtedly, a decrease in the ability of the liver to form proteins plays a leading role. Due to hypoproteinemia, drug pumping out of edema is often ineffective for a long time after the restoration of the strength of the heart.

With scarring of the pericardium or with prolonged decompensation, so-called cardiac cirrhosis often occurs. With abundant growth of connective tissue, it is characterized by the death of the liver substance and in places islets of regenerating liver cells. The proliferation of connective tissue takes place not only around the lobules, but also in their central part. If the proliferation of connective tissue merges, then the pattern of the liver substance becomes unrecognizable. With prolonged stagnation, the capsule thickens due to perihepatitis. For the occurrence of cirrhosis of the liver, it is characteristic that the liver becomes hard, small, with sharp edges, its size is fixed. At the same time, due to portal hypertension, the spleen also begins to swell. It becomes bigger and more solid. In this state, under the influence of treatment that acts on the heart and circulation, neither the magnitude nor the functional disorder of the liver changes. Cardiac cirrhosis is usually accompanied by ascites that is not amenable to medical treatment.

Women's magazine www.BlackPantera.ru: Jozsef Kudas

Book: V. G. Pocheptsov, N. D. Telegina "Congestive liver in heart failure"

The authors, on the basis of their own observations and literature data, characterize the functional state of congestive liver, taking into account the existence of a functional relationship between the circulatory apparatus and the liver. A comparative assessment of the effectiveness of the treatment of chronic circulatory insufficiency is given, both with and without taking into account changes in liver function. Studying functional state liver is represented by data biochemical research(content total bilirubin, total protein, protein fractions, the content of copper, 17-ketosteroids and catecholamines in the daily urine, the content of enzymes in the blood serum).

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Today, 4 out of 5 people in our country have liver disease. Most of them are men from 18 to 65 years old. Among the most common diseases is congestive liver, which is accompanied by heart failure.

Stagnation of the liver is a frequent phenomenon, because every day the body performs voluminous work on the release of bile.

Causes

Stagnation of the liver is a frequent phenomenon, because every day the body performs a lot of work on the release of bile. The mechanism is very complex and due to the branching of the ducts, the process is not always successful, which leads to cholestasis. Common causes are the following factors:

Violations in the work of the liver, if they are started, begin to affect the work of the heart. Which leads to heart failure. With such a tandem, the disease can proceed for decades. It is necessary to conduct an examination for liver enlargement if the heart fails.

Symptoms and Diagnosis

Let's look at three main reasons.

First reason. Blocking of the bile ducts with a calculus (stone). This is a complication that occurs when gallstone disease. In this case, stones are formed in the liver that interfere with normal functioning.

The symptom is sudden acute pain under the ribs right side, as a result of overvoltage and malnutrition. The occurrence of discomfort is due to the closure of the duct, its subsequent increase and growth of the liver. Other signs of liver dysfunction may include nausea, vomiting, and chills.

The second reason. Deformation of the gallbladder. Bend - the problem is often congenital. Only sometimes it can manifest itself unexpectedly for a person throughout a life span. The inflection occurs in the neck, in the organ itself, the bottom or in the excretory duct.

Symptoms are not pronounced, and may not appear at all. From possible phenomena concerned about a slight discomfort in the right hypochondrium, bloating, lack of appetite, nausea before and after meals. However, severe pain can visit if there is an overlap of the duct or cervix.

Third reason. Cancer neoplasms are very insidious, because they appear only when the patient's standard of living decreases and it is visible outwardly. The tumor grows into the ducts and causes cholestasis. Moreover, its initial position may not be in the liver itself, but in nearby organs.

Congestive liver in heart failure affects the entire body. In people with weak veins, for example, clinical symptoms expansion and blockage of veins. Allergy sufferers experience suffocation, dryness and itching of the skin. With cancer, a tumor grows in patients due to the accumulation of poisons and toxins, which gallbladder unable to output. Rheumatic people, even having cured rheumatism, get a complication. People with headaches are at risk of more frequent attacks. Symptoms may be accompanied by blood stasis in the liver.

Consider classic signs stagnant liver:

Heart problems indicate congestive liver

1. Chronic fatigue.
2. Deterioration of attention.
3. Anxiety.
4. Violation in the work of the heart.
5. Exacerbation of chronic diseases.
6. Inflammatory processes in the lymph nodes.
7. Weight set.
8. An increase or decrease in blood pressure.
9. Increased sweating.
10. Problems with dry and oily skin.
11. Cracks around the mouth, on the heels.
12. Skin fungi of various kinds.
13. Prolonged inflammation nail plates on the arms and legs, etc.

Any weakness in the body can make itself felt in cardiac cirrhosis. To confirm the disease, you need to contact a specialist and undergo a series of examinations. Take a blood test to check for an increase in bilirubin, undergo an ultrasound abdominal cavity.

Treatment

Good for annoying itching antihistamines and hepatoprojectors. For example, Heptal.

If a mechanical obstruction is found in the ducts, then endoscopic intervention by the surgeon will be applied.

Prevention and diet

Congestive liver requires prevention. The rules are extremely simple:

Prevention of stagnant liver is proper nutrition

1. Eat right.
2. Control physical activity.
3. Support the liver with medication.
4. Do not abuse alcoholic beverages.

For patients with this diagnosis, a diet is recommended. It includes a ban on neutral fats. The amount of these substances allowed for use is up to 40 grams per day. Meals in small portions in 6 doses. Include vegetable and animal protein in your diet. Banned are onions, garlic, radishes, sorrel, spinach, mushrooms, turnips, radishes. It is strictly forbidden to drink alcohol, fried, fatty foods, fatty species meat.

Include in your diet fat soluble vitamins. This will help fill the gap useful substances. Take calcium.

A nutritionist will help you create an individual dietary program by determining the degree of the disease. It will take into account the daily needs of trace elements. And it will help to avoid problems with weight and liver function. Balance your diet and improve your overall health.

Video

Breathing practice for the treatment of the liver and gallbladder.

Congestive (cardiac) cirrhosis is a chronic progressive liver disease, manifested by necrosis of hepatocytes, caused by congestion in the cardiovascular system, and in particular in the portal (portal) vein system. The term "congestive liver" can also be found in the literature. This disease occurs most often over the age of 45-55 years, in combination with long-term severe heart failure. Men and women suffer from this cirrhosis on average in the same ratio. The rate of development of congestive cirrhosis is 5-10 years from the onset of the process to the development of severe liver failure.

Causes

The main causes of congestive cirrhosis:

• Chronic cor pulmonale;
• Insufficiency of the tricuspid (tricuspid) valve;
• Mitral valve insufficiency;
• Myxoma in the right atrium;
• Pericarditis, constrictive form;
• Cardiosclerosis.

The process of development of cardiac cirrhosis of the liver is quite simple. Due to insufficiency of venous circulation and stagnation of blood in the right ventricle of the heart, there is an excessive filling of the center of the liver with blood, its central veins (central portal hypertension). This leads to the development of local hypoxia ( oxygen starvation hepatocytes). In the hepatic lobules, dystrophy occurs, then atrophy and necrosis. To replace dead cells, the body produces collagen and liver fibrosis develops, which further exacerbates the situation.

Symptoms of congestive cirrhosis

The main signs of the development of congestive cirrhosis of the liver:

• Pain in the right hypochondrium, discomfort and heaviness in the liver. They are quite pronounced, they disturb the patient much more than in other forms of cirrhosis;
• Bloating
• Minor jaundice ( this symptom may be missing);
• Vomiting and nausea (can be up to several times a day);
• Slight enlargement of the spleen;
• General weakness;
• Loss of appetite;
• swelling;

Diagnostics

For the diagnosis of congestive cirrhosis, first of all, anamnesis is important, during the collection of which the doctor notes the presence of cardiac pathology in the patient. During examination and palpation, an increase in the size of the liver is noted (the lower edge reaches the navel), its edge is even, dense and painful.

Additional examination methods:

• Blood test for liver tests. There is a moderate increase in total bilirubin and its fractions, a decrease in albumin levels, a moderate increase alkaline phosphatase and ASAT.
• Ultrasound of the liver. A significant increase in the liver and signs of cirrhosis of the central lobules are characteristic. If there is free fluid in the abdominal cavity, it reveals signs of ascites.
• Liver biopsy. Congestion in the liver lobules, signs of sclerosis and necrosis are revealed.

Treatment of congestive cirrhosis

Treatment of congestive cirrhosis of the liver is based on therapeutic measures to compensate for heart failure. If you stabilize the work of the heart, then the progression of cardiac cirrhosis stops.

As maintenance therapy in case of this disease carry out the introduction of a solution of albumin. It allows you to maintain and improve protein metabolism, somewhat improves the functioning of hepatocytes, reduces swelling and ascites.

Diuretics are also prescribed to eliminate edema and ascites. The most effective in this case is Veroshpiron. He brings out excess liquid and maintains ionic balance in cells.

Dieting is also necessary for congestive liver. Food should be rich in protein and slightly increase fat in the diet. These are products such as milk, kefir, cottage cheese, sour cream, any meat, fish, eggs, caviar, soy, legumes. Also, as a supplement to food, any dietary supplements based on amino acids are well suited.

Complications

The most common complications of congestive cirrhosis are:

• Hepatic coma;
• Varicose veins of the esophagus, rectum and portal vein;
• Bleeding from varicose veins;
• Hepatocellular carcinoma;
• Ascitic sepsis and peritonitis;
• Death.

Prevention

The only way to prevent the development of congestive cirrhosis is to timely contact a cardiologist with heart problems, quality treatment these diseases and maintaining the heart and blood vessels in a state of compensation.

Chronic heart failure is a chronic pathological condition that is caused by a decrease in myocardial contractility.

Many causes can lead to this condition, including high blood pressure, heart defects, alcohol abuse, diabetes, inflammatory diseases hearts, ischemic disease hearts, etc.

Distinguish between left and right ventricular heart failure. Exactly chronic insufficiency right ventricle to final stages and leads to cardiological cirrhosis of the liver.

Chronic heart failure develops under the influence of pathological factors that lead to the following:

• organic or functional disorders heart muscle, heart valves (heart defects)
• Excessive work of the heart (alcoholism, diabetes, blood pressure, etc.)
• Combination of the first two factors

For these reasons, symptoms of chronic right ventricular heart failure develop:

• Shortness of breath, at first physical activity, then at rest
• Decreased performance
• Edema of the upper and lower extremities
• Liver damage

Causes of development of cardiological cirrhosis of the liver

Right ventricular failure is expressed in the fact that the heart does not perform its function of a blood pump in full. Decreased blood flow velocity big circle circulation, including the liver.

Stagnation of blood begins, both in the liver and in other organs. Due to the increased blood pressure the liquid part of the blood passes into the liver tissue, causing swelling.

• Hypoxia of hepatocytes
• Decrease and necrosis of hepatocytes
• Development of portal hypertension
• collagen formation, fibrosis
• With increased blood stagnation, the growth of connective tissue increases, the destruction of the structure of the liver

Symptoms of cardiac cirrhosis of the liver

For cirrhosis of the liver associated with cardiac pathology, all the symptoms of other types of the disease are characteristic:

• Fatigue, loss of appetite, weight loss
• Violations gastrointestinal tract(flatulence, vomiting, nausea)
• Phlebeurysm
• Abdominal enlargement, ascites
• Edema of the lower extremities
• Bleeding from the esophagus, stomach, etc.
• Jaundice
• Increase in body temperature
• signs hepatic encephalopathy(changes in the rhythm of sleep and wakefulness, difficulty in doing the usual things, changes in behavior, etc. up to a violation of consciousness)
• Pain in the right hypochondrium
• Enlarged liver, spleen
• Head of a jellyfish - expansion of veins on the skin of the abdomen

There are also signs that are typical for a stagnant liver:

• The disappearance or reduction of symptoms of cardiac cirrhosis after treatment of heart failure, bringing positive results
• On initial stages process, the liver is enlarged, soft to the touch, in later stages the liver becomes a typical dense consistency
• On palpation and pressure on the liver area, the veins of the neck swell

However, with the further development of the process, the treatment of heart failure does not affect the liver pathology. This means that cardiac cirrhosis of the liver has fully developed.

Also, cardiological cirrhosis of the liver is characterized by changes in blood tests (anemia, leukocytosis), urine (erythrocytes, protein), feces (acholia - a decrease in stercobilin), blood biochemistry (increased transaminases, alkaline phosphatase, gamma-GGT, fructose-1-phosphate aldolase, arginase , prothrombin time, bilirubin, globulin, decrease in albumin, cholesterol, fibrinogen, prothrombin.

On ultrasound, an enlarged liver with a uniformly increased echogenicity, an enlarged spleen is determined. Liver biopsy gives a characteristic picture of cirrhosis, if possible.

Cardiac cirrhosis of the liver: treatment

First of all, a diet is prescribed with a restriction of fatty, fried, smoked foods, salt and spices are limited. Required complete failure from bad habits.

The following drugs are used to correct chronic heart failure:

1. Cardiac glycosides (digoxin, dobutamine) are used to strengthen and protect the myocardium
2. Beta-blockers (atenolol, bisoprolol, metoprolol, propranalol, bopindolol, timolol) are necessary to normalize blood pressure
3. Diuretic drugs (hypothiazid, spironolactone, furosemide) reduce swelling, they also help in the treatment of ascites

used to treat cardiac cirrhosis of the liver various groups drugs, depending on the degree of activity and stage of compensation:

1. Vitamin therapy (vitamins of groups B, C are prescribed)
2. Hepatoprotectors - drugs that protect the liver from damage (Essentiale, Heptral)
3. If complications arise, they are treated

Cardiac cirrhosis of the liver: prognosis

The prognosis, as in the case of other types of cirrhosis, depends on the stage of compensation. Compensated cirrhosis allows you to live quite a long time, often more than 10 years.

Decompensated cardiac cirrhosis of the liver has a much worse prognosis: most often, life expectancy is no more than 3 years. With the development of bleeding, the prognosis is poor: mortality is about 40%.

Ascites also affects life expectancy for the worse. Survival at 3 years is only 25%.

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