One of the organs that suffers most in heart failure is undoubtedly the liver. Its enlargement is the general rule in right congestive heart failure as well as in total ventricular failure. But if it is easy to appreciate the anatomic alterations—enlargement, tenderness, hardness and the like—the functional attack often passes unnoticed or at least is clinically underestimated. It is only in the advanced stages when subicterus, or rarely icterus, appears or when digestive disturbances become important that the physician directs his attention toward the liver and admits the existence of hepatic insufficiency. Nevertheless, at much earlier stages of congestion laboratory procedures already show the functional attack of the gland.
It is conceivable that this hepatic involvement should be practically inevitable in heart failure, even in its early stages, as a result of a combination of factors: first, the engorgement of the organ with its consequent effects on the nutrition
CHÁVEZ I, SEPÚLVEDA B, ORTEGA A. THE FUNCTIONAL VALUE OF THE LIVER IN HEART DISEASE: AN EXPERIMENTAL STUDY. JAMA. 1943;121(16):1276–1282. doi:10.1001/jama.1943.02840160026006
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