Muscat liver is a consequence of chronic congestive venous congestion of the internal organs. This condition affects not only the digestive system, but also the heart, lungs, kidneys, and brain.
Classification
Three stages of changes occurring in the liver morphologically are distinguished as the disease progresses:
- Muscat liver: against the background of fatty degeneration of cells (yellow color), dilated vessels (dark red color) are visible.
- Congestive fibrosis: the tissue is denser due to the germination of connective tissue. Blood impregnates the organ parenchyma, and foci of sclerosis also appear.
- Cardiac cirrhosis: the surface of the organ acquires a tuberous appearance.
Etiology
Violation of the outflow of blood from the portal vein system leads to the formation of such a phenomenon as a muscular liver. The causes of stagnation are dysfunction of the ventricles of the heart and a decrease in venous return. These are manifestations of heart failure, and often they accompany coronary heart disease. Increased pressure in the venous system, as well as the accumulation and stagnation of blood in the vessels, impede effective blood flow in the organs.
Epidemiology
The disease is not related to gender or age. But statistically most often, men of old age and old age suffer from it. Most often, only at autopsy it can be determined that the patient had a nutmeg liver. Pathology can provide answers to questions that interest the attending physician. For this, the organs are not only visually evaluated, but also sent for
histological examination.
Risk factors for the development of liver pathology are physical inactivity, malnutrition, bad habits, a history of heart disease, as well as the elderly person.
Clinic
In most cases, symptoms of heart failure prevail in the clinical picture of the disease, so the patient may not suspect that he has problems with the liver. Muscat liver, like any other cirrhosis, is manifested by pain in the right hypochondrium, yellowness of the skin and mucous membranes, swelling on the legs at the end of the day, ascites (accumulation of fluid in the abdominal cavity). But these are all indirect signs. A 100% diagnosis can only be made after an autopsy, because none of the modern imaging methods can show whether the organ resembles nutmeg. The palpation of the liver will be dense, its edge is rounded and protrudes from under the costal arch.
Diagnostics
In order to diagnose chronic passive venous congestion, it is necessary:
1. Confirm the presence of heart failure (instrumental or physical examination):
- chest x-ray (indicates a change in heart, venous congestion in the lungs or the presence of effusion);
- Doppler study of the heart and inferior vena cava (to identify the causes of heart disease);
- CT or MRI;
- ECG.
2. Conduct laboratory tests, such as biochemical blood tests and liver tests :
- bilirubin in the blood rises;
- transaminases (ALT, AST) increase moderately;
- increase in alkaline phosphatase content;
- decreased albumin and prolonged blood coagulation time.
3. To resort to instrumental diagnostics in order to morphologically establish the fact of degeneration of the liver. Such studies include:
- laparocentesis (aspiration of free fluid from the abdominal cavity) to establish the causes of ascites;
- puncture biopsy (to confirm the diagnosis of “muscat liver”, a micropreparation can be made during the patient’s life).
Comparative diagnostics are carried out with diseases such as alcoholic cirrhosis, oncological heart diseases, hemochromatosis, inferior vena cava thrombosis and portal hypertension. Do not forget about viral diseases of the liver - hepatitis A, B, C, D, E. In addition, there is the likelihood of a parasitic disease.
Complications
Muscat liver and cardiac cirrhosis causing it do not affect the outcome of heart failure. Cases in which acute liver failure has caused death are rare and cannot be considered indicative. Blood coagulation disorders are also quite rare, although not unprecedented. Some experts suspect that there is a connection between cirrhosis of the liver and the occurrence of its malignant neoplasms, but this theory has not yet been proved.
Treatment
Drug therapy should be aimed at eliminating the underlying disease, that is, heart failure. And cirrhosis itself does not have specific therapy. In addition, the patient is advised to follow a diet with limited salt attorney and change his daily routine in order to get enough sleep, be in the fresh air and get enough exercise. These simple manipulations will help reduce blood pressure in the great vessels, including the portal vein.
Symptomatic therapy consists of taking diuretics (to reduce the amount of fluid in the abdominal cavity), as well as beta-blockers and ACE inhibitors (to normalize heart function).
Surgical treatment is usually not performed. This carries a great risk to the patient and does not justify itself. Sometimes the doctor may decide to bypass the intrahepatic part of the portal vein, but this can lead to severe heart failure in the right ventricular type and pulmonary edema due to a sharply increased venous return.