In cases of congestive heart failure, varying degrees of passive congestion of the liver universally occur from the resulting stasis in the portal circulation. Chronic passive congestion of the liver becomes evident when heart failure becomes protracted or frequently recurrent. At times the liver increases enormously in size, so that it reaches the level of the umbilicus or even lower. Not infrequently the degree of portal stasis is disproportionate to the stasis in the systemic circulation, probably owing to the fact that a greater degree of obstruction to the blood flow from the hepatic veins occurs than to that in the inferior vena cava. Likewise, the capillaries of the portal system are possessed of a relatively high degree of permeability.
The effects of chronic passive congestion on the liver have been the subject of much controversy for nearly a century, the issue involved chiefly concerning the production of hepatic cirrhosis.
BOLAND EW, WILLIUS FA. CHANGES IN THE LIVER PRODUCED BY CHRONIC PASSIVE CONGESTION: WITH SPECIAL REFERENCE TO THE PROBLEM OF CARDIAC CIRRHOSIS. Arch Intern Med (Chic). 1938;62(5):723–739. doi:https://doi.org/10.1001/archinte.1938.00180160002001
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