NUTMEG LIVER
e The term “Nutmeg” refers to the
appearance of liver in chronic venous
congestion which resembles the
appearance of speckled nutmeg Kernel
e Etiology: Most common cause is right
heart failure. Other causes include
obstruction of blood flow in hepatic
vein and inferior venacava.
e Pathogensis: Due to right heart failure,
there is increased pressure in the
hepatic veins. Hepatic veins are
congested and stasis of blood causes
deoxygenation of hepatocytes.
Centrilobular hemorrhagic necrosis
occurs which is surrounded by paler
zone which contains damaged
hepatocytes with fatty change.Adjacent to this zone normal
unaffected hepatocytes are present
which are adjacent to hepatic arteriole
and are better oxygenated.
Gross Morphology: Liver is enlarged
and firm in consistency. Cut section
shows alternating red areas
representing congested and dilated
hepatic vein and paler areas of fatty
change giving the appearance of
Nutmeg kernel.
Microscopy :
Dilated and congested hepatic veinules
with centrilobular hemorrhagic
necrosis of hepatocytes.
Periphery shows fatty change in
hepatocytese Hepatocytes adjacent to portal triad
are normal.
e Later fibrosis may develop and
condition is called as “Cardiac
Cirrhosis”
NORMAL HEPATIC LOBULE CVC LIVER
PORTAL TRIAD,
cenrea Vein —
| __Noemar
HEPaIocrHs