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Congestive hepatopathy
Other Resources UpToDate PubMed

Congestive hepatopathy

Contributors: Matthew Rasmussen, Jennifer J. Findeis-Hosey MD
Other Resources UpToDate PubMed


Congestive hepatopathy is liver dysfunction secondary to circulatory dysfunction, especially right-sided heart failure, involving chronic hepatic congestion and eventually leading to fibrosis. In later stages, the condition is often referred to as "cardiac cirrhosis," although it does not always meet the strict definition of cirrhosis. However, individuals with advanced disease may have liver findings that are indistinguishable from chronic liver disease or cirrhosis.

Congestive hepatopathy is usually secondary to right-sided heart failure, which causes passive congestion of the liver leading to hepatic sinusoidal dilation and edema. Sinusoidal thrombosis and mechanical stress cause atrophy of centrilobular (zone 3) hepatocytes. Leakage of blood and protein-rich fluid into the space of Disse can activate hepatic stellate cells and promote centrilobular fibrosis. As this disease process progresses, fibrosis may bridge between liver lobules. Progressive congestive hepatopathy can cause portal hypertension leading to ascites and compression of bile canaliculi. inhibiting normal bile flow. Hepatic synthetic function may also be affected. Case reports suggest that fibrosis may improve with proper management of the underlying condition causing the hepatic congestion.

Most patients with congestive hepatopathy are older adults with right-sided heart failure; however, this entity may also be present in pediatric patients who have had certain surgical procedures for congenital heart disease. This phenomenon has been best characterized in patients who have had a Fontan procedure for an anatomic or functional single ventricle. After a Fontan, systemic venous pressures are 3-4 times greater than normal, and these patients develop progressive hepatic fibrosis.

Congestive hepatopathy is often asymptomatic, or the symptoms are masked by those of right heart failure. When symptomatic, patients often have a dull right upper quadrant pain. The liver may be enlarged and firm, and patients may experience malaise, nausea, vomiting, anorexia, and early satiety. Signs of right-sided heart failure will likely be present and include jugular venous distension, hepatojugular reflux, and lower extremity edema; about 25% of patients will have ascites. In the case of right heart failure due to tricuspid regurgitation, patients may have a pulsatile liver early in the disease process, which will diminish over time with progressive fibrosis. Jaundice, spider angiomata, and splenomegaly are only rarely present. Encephalopathy may occur in these patients secondary to cerebral hypoperfusion rather than hepatic encephalopathy. Esophageal varices are not present due to lack of a pressure gradient between the hepatic and portal venous systems.


K76.1 – Chronic passive congestion of liver

74669004 – Cardiac Cirrhosis

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Differential Diagnosis & Pitfalls

Cardiac causes of congestive hepatopathy:
  • Dilated cardiomyopathy
  • Alcoholic cardiomyopathy
  • Constrictive pericarditis (see Pericarditis)
  • Cardiogenic shock
  • Pulmonary hypertension
  • Restrictive cardiomyopathy
  • Tricuspid regurgitation
  • Pulmonic stenosis
  • Pulmonary embolism
  • Chronic obstructive pulmonary disease / Cor pulmonale
  • Congestive heart failure
  • Acute coronary syndrome
  • Mitral valve stenosis
Other hepatic injuries:
  • Budd-Chiari syndrome
  • Acute cardiogenic liver injury
  • Biliary tract obstruction
  • Hemochromatosis
  • Portal vein obstruction
  • Drug-induced hepatotoxicity (eg, nifedipine, diltiazem, or amiodarone)
  • Metabolic dysfunction-associated steatotic liver disease
  • Sinusoidal obstruction syndrome
  • Hepatic infarction

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Last Reviewed:03/15/2018
Last Updated:04/16/2018
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Congestive hepatopathy
A medical illustration showing key findings of Congestive hepatopathy : Hepatomegaly, Jaundice, Hyperbilirubinemia, Peripheral leg edema, PT prolonged, RUQ pain
Copyright © 2024 VisualDx®. All rights reserved.