21. Central haemorrhagic necrosis: Difference between revisions

'''Causes''': Chronic right ventricular failure + acute left ventricular failure

'''Theory''':[[File:Central haemorrhagic necrosis of the liver - nutmeg liver slide.png|thumb|Overview of a different slide with nutmeg liver but without central haemorrhagic liver necrosis]]Chronic right ventricular failure has a backward failure symptom called ''nutmeg liver'' or ''hepar moschatum''. You can read about the mechanisms of backward failure in pathophysiology. The right-sided heart failure causes congestion of the venous system, which affects the liver. Recall from anatomy that the central vein is the vein that drains into the hepatic vein and eventually the inferior vena cava, while the veins in the portal triad originate from the portal vein. When the right ventricle fails will congestion occur in the inferior vena cava and therefore the central veins, but not the portal vein. The signs of congestion are therefore most prominent around the central vein. The congestion in the liver causes RBCs to filter out from the vessels into the sinusoidal spaces. Fibrosis occurs around the portal triad, a process called ''incipient periportal fibrosis''. Atrophy of hepatocytes occurs. Some fatty degeneration of the hepatocyte is also visible.[[File:Central haemorrhagic necrosis of the liver - atrophic cells.png|thumb|Atrophied cells. Sinusoidal congestion is also visible]]That was the case of nutmeg liver. Despite it not being in the topic list is it still possible to draw nutmeg liver as a slide on the exam! It’s similar to this slide in all ways except there is no necrosis around the central veins.