Cardiac cirrhosis

Shock liver 2. Acute fiver congestion 1. Chronic liver congestion 2. Congestive fibrosis 3. Cardiac cirrhosis... 

Constrictive pericarditis The clinical picture and hepatic changes of the liver are similar to those of the Budd-Chiari syndrome. Considerable thickening of the liver capsule may resemble sugar icing. The liver is enlarged and firm. Tense ascites is present. Histologically, the changes resemble those of cardiac cirrhosis. 

Wanless, I.R., Liu, J.J., Butany, J. Role of thrombosis in the pathogenesis of congestive hepatic fibrosis (cardiac cirrhosis). Hepatology 1995 21 1232-1237... 

Hereditary hemochromatosis is an autosomal recessive disease of increased intestinal iron absorption and deposition in hepatic, cardiac, and pancreatic tissue. Hepatic iron overload results in the development of fibrosis, hepatic scarring, cirrhosis, and hepatocellular carcinoma. Hemochromatosis can also be caused by repeated blood transfusions, but this mechanism rarely leads to cirrhosis. 

In livestock, selenium has been found to be the cause of blind staggers and alkali disease. Blind staggers occurs as a result of acute ingestion of seleniferous plants and is characterized by impaired vision, depressed appetite, a tendency to wander in circles, paralysis, and death from respiratory failure. A more chronic syndrome described in horses and livestock is alkali disease, which also is associated with consumption of grains or plants containing selenium. The disease is characterized by lack of vitality, loss of appetite, emaciation, deformed hoofs, loss of hair, erosion of the joints of long bones, anemia, cirrhosis, and cardiac atrophy ... 

Dinretics are widely used in medicine for very diverse pathologies, primarily for relieving edema, treating hypertension, cardiac insufficiency, hypercalcinuria, glaucoma, and a few forms of epilepsy, liver cirrhosis, and nephrosis. 

Bendroflnmethiazide may be nsed for the same indications as the aforementioned drugs however, it is primarily used as an adjnvant agent for reheving edema associated with cardiac insnfficiency, liver cirrhosis, and edema cansed by taking corticosteroids. Synonyms of this drng are sinesalin, docidrazine, tensionorm, aprinox, naturetin, and others. 

Prevention of potassium depletion when dietary intake is inadequate in the following conditions Patients receiving digitalis and diuretics for CHF significant cardiac arrhythmias hepatic cirrhosis with ascites states of aldosterone excess with normal renal function potassium-losing nephropathy certain diarrheal states. 

Diseases that directly affect hepatic integrity include cirrhosis, viral infections, and collagen vascular diseases. Diseases that indirectly affect function include metabolic disorders (e.g., azotemia secondary to renal insufficiency) and cardiac disease. Although decreased left ventricular output can result in a decrease in hepatic arterial flow, right ventricular failure causes hepatic congestion, reducing the first-pass effect and delaying biotransformation. 

The sites of action within the kidney and the pharmacokinetics of various diuretic drugs are discussed in Chapter 15. Thiazide diuretics are appropriate for most patients with mild or moderate hypertension and normal renal and cardiac function. More powerful diuretics (eg, those acting on the loop of Henle) such as furosemide are necessary in severe hypertension, when multiple drugs with sodium-retaining properties are used in renal insufficiency, when glomerular filtration rate is less than 30 or 40 mL/min and in cardiac failure or cirrhosis, in which sodium retention is marked. 

During the 1970s and 1980s, the synthetic aldosterone antagonist spironolactone (Fig. 17.3) [5] was used extensively (among others) as a diuretic agent for the treatment of edema, liver cirrhosis and certain cardiac diseases. 

This is an autosomal dominant hereditary disorder characterised by a progressive loss of the bile ducts within the liver and narrowing of the bile ducts outside the liver. It is also associated with congenital heart disease, and in particnlar pulmonary stenosis. Symptoms are related to chronic cholestasis and include jaundice, pruritus, pale loose stools and poor growth within the first three months of life. The majority of children have a benign course and many cases go undetected however, there is an overall mortality of 20-30% due to progressive liver disease with the development of cirrhosis, cardiac disease or intercnrrent infection. 

Hepatomegaly is found in most patients with moderately severe heart failure. With progressive cardiac failure, jaundice occurs in about 25% of patients and may progress to necrosis, fibrosis and cirrhosis. 

Spironolactone (Aldactone) is structurally similar to aldosterone and competitively inhibits its action in the distal tubule (exchange of potassium for sodium) excessive secretion of aldosterone contributes to fluid retention in hepatic cirrhosis, nephrotic syndrome and congestive cardiac failure (see specific use in chapter 24), in which conditions as well as in primary h)q)ersecretion (Conn s syndrome) spironolactone is most useful. Spironolactone is also useful in the treatment of resistant hypertension, where increased aldosterone sensitivity is increasingly recognised as a contributory factor. 

Portal pressure is a function of resistance in the portal venous system and ih.e flow of blood through it. In cirrhosis, portal venous resistance is increased, and inflow of blood is increased by splanchnic vasodilatation and elevation of cardiac output. Variceal bleeding is increasingly likely as the pressure gradient between the portal and systemic venous systems rises beyond 12 mmHg. 

Spironolactone (see p. 534) is a competitive aldosterone antagonist which also blocks the mineralocorticoid effect of other steroids it is used in the treatment of primary hyperaldosteronism and as a diuretic, principally when severe oedema is due to secondary hyperaldosteronism, e.g. cirrhosis, congestive cardiac failure. 

Liver diseases severe acute (necrotic) hepatitis, chronic hepatitis, chronic alcoholic liver damage, liver cirrhosis, cardiac liver, liver abscess, liver tumours and liver metastases, toxic liver damage, etc. A severe and, above all, constant reduction in ChE activity (e. g. < 500 U/1) is usually suggestive of an unfavourable prognosis and the foreseeable moment of liver death . 

Acquired liver diseases (e.g. cirrhosis, liver cell necrosis in severe shock (11), pronounced toxic liver damage, cardiac congestion (ll, 17), alcohol-related and medication-induced diseases of the liver) very frequently... 

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