A patient with right hea failure secondary to tricuspid regurgitation is found to have increased liver enzymes. USG shows enlargement of the liver. If the patient is developing 'nutmeg liver', what can be the etiology?
Nutmeg liver is the term given to the transected appearance of the liver in cases of chronic venous congestion (CVC), the alternate dark brown and yellow areas resemble a nutmeg. The yellow area represents area of centrilobular necrosis due to anoxia and the dark red ares represent sinusoidal congestion in the rest of the liver lobule. In chronic cases, fibrous bands can extend from the central vein in zone 3 to the poal tract which looks very much like cirrhosis but is termed cardiac sclerosis and differs from the bridging fibrosis seen in advanced liver disease where the fibrous bands form bridges between poal tracts. The most common etiologies for congestive hepatopathy are constrictive pericarditis, mitral stenosis, tricuspid regurgitation, and cor pulmonale. Ref: Liver: A Complete Book On Hepato (Pancreato) Biliary Diseases By Mahtab, 2009, Page 400 ; Hepatology and Transplant Hepatology: A Case Based Approach By Jawad Ahmad, 2010, Page 116 ; Harrison's internal medicine 16thedition page 1862
CVC
Infarction of liver
Amyloidosis
Budd chiari syndrome