Nutmeg Liver Definition, Symptoms, Causes, Treatment

A condition in which liver get congested is known as nutmeg liver or congestive hepatopathy or passive congestion of the liver. Congestion of liver occurs due to congestion in venous system. Congestive hepatopathy is named as nutmeg because due to chronic congestion of liver, it appear as grated nutmeg “speckled”. The gross image of congested liver shows small black spots representing the both dilated and congested veins of liver or small hepatic venules. The paler area appeared on the gross image is unaffected which surrounds liver tissues. If congestion of liver persist for long term it will lead to fibrosis.

If congestion of liver occurs due to failure in right heart ventricle then this congestion is termed as cirrhosis. Sometimes the sign and symptoms of congestive heart failure covers the signs of cardiac cirrhosis. Most of the time nutmeg liver results in cardiac failure. And the ultimate cause behind it is chronic alcohol use or viral hepatitis. In congestive liver disease, veins get shrink and become small in size leading to increased pressure. This narrowing of veins leads to increased blood pressure and blockage occurs leading to chronic passive congestion of liver also known as nutmeg liver.

Nutmeg liver Symptoms

       
Sign and symptoms are totally depend upon the cause behind it. Mainly symptoms occur after 1st lesions which leads to nutmeg liver. Symptoms are also associated with heart and lungs. Patient feel full and tender in the upper right hypochondriac region. Vomiting containing blood or blood vomiting can occur along with gastrointestinal catarrh. Sometimes jaundice is also reported. Due to obstruction in portal vein, ascites may occur. These ascites lead to generalized edema. Presence of bile in urine and stool have a specific color i.e. light or clay colored. The size of liver increases and it becomes tender.

Nutmeg liver Causes

       
Mainly nutmeg liver occurs as a result of cardiac failure. Due to diseased heart, pressure increases in the sub lobular vein of liver and congestion occurs. Cardiac lesions are also reported as a main cause behind it. Lobules of liver have a red brown colored central portion which stand against non-congested normal tan colored liver. Necrosis also occur in the central portion of hepatic lobules. Lesions in lungs like interstitial pneumonia, pleural effusions and intrathoracic tumors. All the causes mentioned above are directly or indirectly leads to chronic passive congestion of liver or nutmeg liver.

Nutmeg liver Treatment

         
Treatment therapy of nutmeg liver is based on permanently removing the leading cause behind it. But if removal of cause is not possible, then the procedure is modified along with its effects. So, treatment options are limited. Treating congestive heart failure or right heart ventricle disease will ultimately decrease the chances of congestive hepatopathy or nutmeg liver. Lesions in heart and lungs are treated 1st to treat nutmeg liver. Vasodilators are prescribed to dilate vessels and help in ease of blood flow. There is no proper medication for congestion of liver but for the leading cause behind it.