Overview.
Hepatic stasis, also known as passive hepatic congestion (PHC), is the most common complication of congestive heart failure and constrictive pericarditis. Hepatic stasis can be caused by impaired hepatic venous blood return from various causes, increased pressure in the hepatic veins, and passive congestion of the central veins and hepatic sinusoids within the hepatic lobules. At this time, the amount of blood contained in the liver increases, and the liver increases in size, has a tougher texture, and is tender to the touch.
Causes
1. Heart disease
Various types of heart disease, such as heart valve disease, myocardial infarction, pulmonary heart disease, etc., cause right heart insufficiency, or pericardial disease cause right atrial pressure increase, are easy to make the pressure of the inferior vena cava rise, and then transfer to the hepatic vein, resulting in intrahepatic venous blood reflux obstacles, the central hepatic sinusoidal dilatation of bruising. Heart diseases that can cause hepatic stasis include: constrictive pericarditis, rheumatic heart valve disease, arteriosclerotic heart disease and hypertensive heart disease.
2. Venous lesions
Thrombosis of the inferior vena cava, thrombosis of the hepatic vein (Bard-Geary syndrome), scar contraction in multiple plasmacytosis or venous stenosis caused by tumor growth and compression, etc., cause acute or chronic obstruction of the hepatic vein, so that the blood pressure in the hepatic vein rises, and hepatic stasis occurs. Some scholars also believe that it is related to congenital venous malformations, but the cause is still unknown in many patients.
Symptoms
The liver is acutely congested and enlarged, and the hepatic peritoneum is stretched tightly, and the patient may have right upper abdominal pain. Physical examination reveals signs of hepatic jugular venous reflux and mild liver function abnormalities. When heart failure occurs repeatedly in patients with cardiac disease, the liver is enlarged up to 2-10 cm below the costal margin, with increased hardness and smooth surface. The spleen instead shrinks in the early stages. According to the different degree, speed and lesion characteristics of bruising, hepatic bruising can be divided into two types: acute and chronic.
1. Acute hepatic stasis
In patients with acute hepatic stasis, the clinical manifestations include liver enlargement on palpation and distending pain and tenderness in the liver area. Due to hepatic stasis and hypoxia, hepatic dysfunction can be caused, which is manifested by elevated serum aminotransferase, increased urobilinogen, and hepatic excretory function is affected to a certain extent.
2. Chronic hepatic stasis
(1) It is most common in congestive heart failure, and can also occur in right heart failure caused by obstruction of inferior vena cava or hepatic vein, and obstruction of pulmonary circulation. In right heart failure, the pressure in the system of body veins increases, and the liver is affected earlier and more severely than other systems.
(2) Chronic hepatic stasis progresses more slowly, and the degree of liver enlargement is less marked than in acute hepatic stasis. There may be persistent pain in the right upper abdomen, with a sensation of compression on bending or hard palpation. On palpation, the lower edge of the liver is below the rib margin, hard, with bluntly rounded edges. Ascites may be present when there is severe obstruction of the return blood flow to the heart. Liver function is mildly or moderately abnormal, uric acid production and coagulation factor production are reduced, serum albumin is reduced and globulin is increased.
(3) The liver in chronic sludge is enlarged and full, dark red or purple, with bluntly rounded edges and increased hardness. The center of the lobules is dark red, and the surrounding lobules are gray or gray-yellow. The red and yellow colors seem like the pattern of betel nut cut surface, so it is also called betel nut liver (cardamom liver).
Examination
1. Ultrasonography
At the early stage, the liver is enlarged, the lower edge of the liver is blunted, and the echogenicity within the liver is enhanced. The inferior vena cava and hepatic vein are dilated, and the internal diameters of the inferior vena cava and hepatic vein change very little with increased respiratory maneuvers.
2.CT examination
CT manifestations of hepatic stasis include dilatation of the vena cava and hepatic veins, contrast reflux due to elevated central venous pressure, and enhancement of the inferior vena cava and hepatic veins, which are not visualized.On CT enhancement scanning, the hepatic parenchyma may show diffuse heterogeneous speckled and gridded (mosaic-like) enhancement. In addition, CT may show cardiomegaly, hepatomegaly, periportal translucency due to perivascular lymphedema, pleural effusion, ascites, and pericardial effusion, among other changes associated with hepatic stasis.
3. Magnetic resonance imaging (MRI) examination
The liver may show mosaic-like enhancement and low-signal stripes caused by the unenhanced portal vein and hepatic vein, after which the signal intensity of the liver parenchyma becomes more homogeneous in the portal and delayed phases, with gradual enhancement of the portal vein and hepatic vein, and dilatation of the hepatic vein and inferior vena cava above the liver.
4. Laboratory examination
Liver function is mildly or moderately abnormal, uric acid and coagulation factor production are decreased, serum albumin is decreased and globulin is increased. Serum aminotransferases are elevated and urobilinogen is increased.
Diagnosis
Diagnosis is mainly based on ultrasound, CT, magnetic resonance imaging and other imaging tests combined with the results of laboratory liver function tests.
Treatment
The main treatment is to address the etiology and actively control the primary causes of hepatic stasis such as constrictive pericarditis, rheumatic heart valve disease, arteriosclerotic heart disease and hypertensive heart disease.
Questions you may be concerned about
What should I do if I have liver stasis?
Hepatic stasis has many causes, such as heart failure, constrictive pericarditis, etc. Hepatic stasis may occur, and it can be treated according to the cause of the disease.
1. Heart failure: Long-term heart failure can lead to right heart failure, and right heart failure can lead to blood clots in the circulation. Stagnation in the internal circulation can lead to stagnation in the veins of the lower extremities and the hepatic portal vein, and ultimately cause hepatic stagnation.
Commonly used vasodilator drugs, diuretics, cardiotonic drugs for treatment, such as nitroglycerin, furosemide, acetyl furfuryl glucoside and so on. If the patient is in the advanced stage of heart failure, and the effect of various drug treatments is unsatisfactory, heart transplantation can also be considered.
2. Narrowing pericarditis: As the pericardium narrows accordingly and compresses the heart, the amount of blood returned to the heart decreases, resulting in an increase in venous pressure. Due to the elevated venous pressure, body fluids accumulate in the vena cava system causing enlargement of the liver, resulting in hepatic stasis.
Diuretics such as furosemide can be used as prescribed by the doctor, which can relieve symptoms such as ascites and bilateral lower extremity edema; in cases of heart failure or atrial fibrillation with rapid ventricular rate, digoxin can be used, which enhances myocardial contractility, improves pumping function, slows down the heart rate, and improves the pulmonary circulation and body circulation stasis.
If it is caused by tuberculous pericarditis, it should be actively anti-tuberculosis treatment, apply isoniazid, rifampicin and other drugs to standardize the treatment, which can delay the progress of pericardial constriction. If pericardiectomy is performed, anti-tuberculosis treatment should be continued for 1 year.
Patients should consult the doctor in time, complete the relevant examinations, make a clear diagnosis, and then take the appropriate treatment program.