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Heart Disease and the Liver: Pathologic Evaluation

Anne Knoll Koehne de Gonzalez1, Jay H Lefkowitch1

  • 1Department of Pathology and Cell Biology, Columbia University, 630 West 168th Street, PH 15 West, Rm 1574, New York, NY 10032-3725, USA.

Gastroenterology Clinics of North America
|May 17, 2017
PubMed

Insights

Acute heart failure can cause liver injury, manifesting as acute cardiogenic liver injury (ACLI) or congestive hepatopathy (CH). These conditions present distinct histological and laboratory findings, with ACLI showing necrosis and CH leading to fibrosis and cirrhosis.

Area of Science:

  • Cardiology
  • Hepatology
  • Internal Medicine

Background:

  • Liver injury is a known complication of acute and chronic heart failure.
  • Understanding the distinct forms of heart failure-related liver disease is crucial for patient management.

Purpose of the Study:

  • To discuss the concepts of acute cardiogenic liver injury (ACLI) and cardiac or congestive hepatopathy (CH).
  • To outline their clinical manifestations, histological findings, and potential sequelae.

Main Methods:

  • Review of existing literature on heart failure and liver injury.
  • Analysis of histological patterns and laboratory test results associated with ACLI and CH.

Main Results:

  • ACLI histologically shows centrilobular hepatocellular necrosis with elevated aminotransferases.
  • CH is characterized by centrilobular hepatocyte atrophy, sinusoidal dilation, fibrosis, and a cholestatic laboratory pattern.
  • Certain cardiac medications may contribute to liver fibrosis.

Conclusions:

  • ACLI and CH represent distinct pathophysiological processes in heart failure-related liver injury.
  • Histological and laboratory findings differentiate ACLI from CH, guiding diagnosis and prognosis.
  • Further research into medication-induced liver fibrosis in cardiac patients is warranted.

Keywords:
Acute cardiogenic liver injuryCardiac cirrhosisCongestive hepatopathyFontanLiver

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