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CVC -LIVER
HYPEREMIA&CONGESTION
 Hyperemia is an increase in volume of blood in
a particular tissue.
 Its an “active process” , the increased blood
influx results from arteriolar dilatation.
 Congestion, also known as “passive hyperemia”,
results due to stagnation of blood because of venous
obstruction.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 June 2005 07:26 PM)
© 2005 Elsevier
Normal
a. Active Hyperemia (arterial): is an active process
resulting from increased arterial blood inflow because of
arteriolar dilatation.
- The affected tissue is reddened because of engorgement of
tissues with oxygenated blood.
b. Passive hyperemia (Congestion) is a passive
process resulting from impaired venous outflow from a
tissue.
- The affected tissue has a red-blue color due to
accumulation of deoxygenated blood.
PASSIVE HYPEREMIA
OR CONGESTION
Definition:
-Increase in venous blood in an organ as result of
obstruction of venous outflow.
-The veins, venules & capillaries in the organ become
passively dilated (passive hyperemia).
Types:
a. Localized
b. Generalized
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 June 2005 07:26 PM)
© 2005 Elsevier
Congestion
Chronic venous congestion(CVC):-
 In CVC there is long standing accumulation of
deoxygenated blood & hence there is damage to the
tissue.
Mechanism
HEART FAILURE
left heart failure right heart failure
Pressure into
Pulmonary vein
pressure into the
systemic venous system
CVC LUNGS CVC LIVER SPLEEN KIDNEY
CVC Liver
Causes:-
1. Right heart failure
2. Occlusion of inferior vena cava or portal vein.
GROSS APPEARANCE:-
NUTMEG APPEARANCE – Alternate areas of red &
yellow.
Pathological Features of Chronic Venous
Congestion (Liver)
1.Liver
Gross Picture: The
liver is enlarged , firm
and the cut surface
shows alternating dark
areas of congestion
with pale areas of fatty
change, giving the
liver the nutmeg
appearance.
•• • •II••••••• o " ' " ol'"'" j,,.,,
Nutmeg cut surface of the liver (dark areas of
congestion alternating with pale areas of fatty
change)
NUTMEG LIVER
Section of liver showing alternating pale and dark areas with a nutmeg like
appearance possibly due to passive congestion secondary to right sided heart
failure.
CVC Liver (MICRO)
 Blood fills up the central vein & sinusoids
around it. Followed by centrilobular hepatocyte
atrophy and necrosis.
 In the long standing cases the necrotic area is
replaced by fibrous tissue.
 The mid zonal hepatocytes may show
fatty change due to relative hypoxia.
 The areas with blood appears red & areas with
fibrosis appears whitish yellow- NUTMEG
APPEARANCE.
THANK YOU

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  • 2. HYPEREMIA&CONGESTION  Hyperemia is an increase in volume of blood in a particular tissue.  Its an “active process” , the increased blood influx results from arteriolar dilatation.  Congestion, also known as “passive hyperemia”, results due to stagnation of blood because of venous obstruction.
  • 3. Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 June 2005 07:26 PM) © 2005 Elsevier Normal
  • 4. a. Active Hyperemia (arterial): is an active process resulting from increased arterial blood inflow because of arteriolar dilatation. - The affected tissue is reddened because of engorgement of tissues with oxygenated blood. b. Passive hyperemia (Congestion) is a passive process resulting from impaired venous outflow from a tissue. - The affected tissue has a red-blue color due to accumulation of deoxygenated blood.
  • 5. PASSIVE HYPEREMIA OR CONGESTION Definition: -Increase in venous blood in an organ as result of obstruction of venous outflow. -The veins, venules & capillaries in the organ become passively dilated (passive hyperemia). Types: a. Localized b. Generalized
  • 6. Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 June 2005 07:26 PM) © 2005 Elsevier Congestion
  • 7. Chronic venous congestion(CVC):-  In CVC there is long standing accumulation of deoxygenated blood & hence there is damage to the tissue.
  • 8. Mechanism HEART FAILURE left heart failure right heart failure Pressure into Pulmonary vein pressure into the systemic venous system CVC LUNGS CVC LIVER SPLEEN KIDNEY
  • 9. CVC Liver Causes:- 1. Right heart failure 2. Occlusion of inferior vena cava or portal vein. GROSS APPEARANCE:- NUTMEG APPEARANCE – Alternate areas of red & yellow.
  • 10. Pathological Features of Chronic Venous Congestion (Liver) 1.Liver Gross Picture: The liver is enlarged , firm and the cut surface shows alternating dark areas of congestion with pale areas of fatty change, giving the liver the nutmeg appearance. •• • •II••••••• o " ' " ol'"'" j,,.,, Nutmeg cut surface of the liver (dark areas of congestion alternating with pale areas of fatty change)
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  • 12. NUTMEG LIVER Section of liver showing alternating pale and dark areas with a nutmeg like appearance possibly due to passive congestion secondary to right sided heart failure.
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  • 14. CVC Liver (MICRO)  Blood fills up the central vein & sinusoids around it. Followed by centrilobular hepatocyte atrophy and necrosis.  In the long standing cases the necrotic area is replaced by fibrous tissue.  The mid zonal hepatocytes may show fatty change due to relative hypoxia.  The areas with blood appears red & areas with fibrosis appears whitish yellow- NUTMEG APPEARANCE.
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