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→Autopsy Findings
== Clinical Summary ==
This 57-year-old male was hospitalized with a three-month history of a dry, hacking cough, dyspnea, and chest pain. He was diagnosed as having congestive heart failure. There was no evidence of myocardial infarction, but renal and hepatic functions were decreased. The patient developed refractory congestive heart failure and renal failure. The patient's cardiac index was marginal and he was classified as a having congestive cardiomyopathy. The patient had a cardiorespiratory arrest and died two months after admission.
== Images ==
File:IPLab4ChronicPassiveCongestion9.jpg|This is a gross photograph of the cut surface of a liver with chronic passive congestion (left) compared to the cut surface of a nutmeg (right).
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== Virtual Microscopy ==
=== Liver Chronic Passive Congestion ===
<peir-vm>IPLab4ChronicPassiveCongestion</peir-vm>
=== Normal Liver ===
<peir-vm>UAB-Histology-00149</peir-vm>
== Study Questions ==
* <spoiler text="What is the most common cause of chronic passive congestion of the liver?">Right-sided heart failure. Also, obstruction of the inferior vena cava or hepatic vein (usually associated with neoplasia and/or a hypercoagulable state leading to thrombosis) can cause hepatic congestion</spoiler>
* <spoiler text="Why is the central vein region most severely affected by chronic passive congestion?">The central vein region is farthest away from the arterial (oxygenated) blood so this region has the lowest oxygen tension anyway. With congestion and stasis, this central vein region becomes hypoxic which results in liver cell atrophy and necrosis. The peripheral regions are hypoxic but and develop fatty change. Thus, the dark red, congested, and necrotic central vein region that is surrounded by yellow fatty change gives the morphology that is termed "nutmeg liver."</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/151792-overview eMedicine Medical Library: Cardiac Cirrhosis and Congestive Hepatopathy]
* [http://emedicine.medscape.com/article/156330-overview eMedicine Medical Library: Myocarditis]
* [http://emedicine.medscape.com/article/2069746-overview eMedicine Medical Library: Pediatric Congestive Heart Failure]
* [http://www.merckmanuals.com/professional/hepatic_and_biliary_disorders/fibrosis_and_cirrhosis/cirrhosis.html Merck Manual: Cirrhosis]
=== Journal Articles ===
* Naschitz JE, Slobodin G, Lewis RJ, Zuckerman E, Yeshurun D. [http://www.ncbi.nlm.nih.gov/pubmed/10874271 Heart diseases affecting the liver and liver diseases affecting the heart]. ''Am Heart J'' 2000 Jul;140(1):111-20.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/672-chronic_passive_congestion PEIR Digital Library: Chronic Passive Congestion Images]
* [http://library.med.utah.edu/WebPath/LIVEHTML/LIVERIDX.html#1 Webpath: Hepatic Pathology]
== Related IPLab Cases ==
* [[IPLab:Lab 8:Hepatitis B|Lab 8: Liver: Hepatitis B]]
{{IPLab 4}}
[[Category: IPLab:Lab 4]]