A liver biopsy reveals following findings. What is true about this condition
Correct Answer: Nutmeg liver with dark areas of perivenular dead hepatocytes and gray areas of periportal viable hepatocytes
Description: This is a classical picture of nutmeg liver seen in chronic passive venous congestion on the liver.
The dark congested areas consist of necrotic hepatocytes while the surrounding paler and brownish appearing regions are viable hepatocytes.
"The combination of hypoperfusion and retrograde congestion acts synergistically to cause centrilobular hemorrhagic necrosis.
The liver takes on a variegated mottled appearance, reflecting haemorrhage and necrosis in the centrilobular regions.
This finding is known as nutmeg liver due to its resemblance to the cut surface of a nutmeg. ”
— Robbins 9/e p864
Passive Congestion and Centrilobular Necrosis Hepatic manifestations of systemic circulatory compromise-passive congestion & centrilobular necrosis can be seen in both left & right-sided heart failure.
Pathology
Right-sided cardiac decompensation leads to passive congestion of the liver.
The liver is slightly enlarged, tense, and cyanotic, with rounded edges.
Microscopically there is congestion of centrilobular sinusoids.
With time, centrilobular hepatocytes become atrophic, resulting in markedly attenuated liver cell plates.
Left-sided cardiac failure or shock may lead to hepatic hypoperfusion & hypoxia, causing ischemic coagulative necrosis of hepatocytes in the central region of the lobule (centrilobular necrosis). Combination of hypoperfusion & retrograde congestion acts synergistically to cause centrilobular hemorrhagic necrosis.
The liver takes on a variegated mottled appearance, reflecting hemorrhage & necrosis in the centrilobular regions.
This finding is known as nutmeg liver due to its resemblance to the cut surface of a nutmeg.
Category:
Pathology
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