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Congestive Hepatopathy — EECC MCQ

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ModerateGeneral CardiologyCongestive HepatopathyEECC

A 55-year-old woman with dilated cardiomyopathy develops progressive liver dysfunction with elevated bilirubin, elevated INR, and ascites. Her right heart pressures are significantly elevated (RA 18 mmHg, RV systolic 65 mmHg). Liver ultrasound shows hepatic vein dilatation without cirrhosis. What is the most likely hepatic diagnosis?

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Correct answer: A — Congestive hepatopathy (cardiac hepatopathy) — chronic hepatic congestion from right heart failure causing a clinical picture that can mimic liver cirrhosis

Congestive hepatopathy results from chronic passive congestion of the liver due to elevated right-sided cardiac pressures (elevated RA pressure transmitted to the hepatic veins). Features include: (1) hepatomegaly; (2) elevated bilirubin (both conjugated and unconjugated); (3) elevated INR (impaired hepatic synthetic function); (4) ascites (from hepatic venous congestion and portal hypertension); (5) dilated hepatic veins and IVC on ultrasound. Chronic congestive hepatopathy can progress to cardiac cirrhosis (fibrosis around central veins — 'nutmeg liver' on pathology). Management targets the underlying RHF: diuretics, afterload reduction, treatment of the cardiac cause. Hepatic function often improves with effective decongestion. MELD-XI score (excluding INR, which is confounded by anticoagulation) is used for transplant listing in cardiac patients.

Reference: ESC (2023): HF Guidelines