intrahepatic vs posthepatic portal HTN

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is CHF a cause of intrahepatic portal hypertension or posthepatic portal hypertension? goljan rapid review says intrahepatic (page 228, 2004 edition) but brs path says posthepatic. which one is it and why?

 

[fakin' the funk]

is CHF a cause of intrahepatic portal hypertension or posthepatic portal hypertension? goljan rapid review says intrahepatic (page 228, 2004 edition) but brs path says posthepatic. which one is it and why?

I think you'd be safe going with posthepatic. It's what Robbins says, and it makes sense - the actual problem (the hydrostatic disturbance) in R-sided CHF is indeed posthepatic.

Robbins cites cirrhosis as the major intrahepatic cause. I.e., we're talkin' hepatocyte dysfunction here. Perhaps you could argue that chronic passive congestion of hepatocytes in R-sided CHF could lead to cirrhosis...but that'd be a stretch, wouldn't it?

 

[guitarguy09]

this is interesting... on p.883 of Robbins it says major post-hepatic causes are severe right-sided HF, constrictive pericarditis, and hepatic vein outflow obstruction... and all seems well with this until you look further. I don't understand why on that page is says one thing, and then on p.917-919 it lists "right-sided cardiac decompensation leading to congestion of the liver" and "left-sided cardiac failure/shock leading to hypoperfusion (together act to generate centrolobular hemorrhagic necrosis, i.e. nutmeg liver) under the section titled "Impaired blood flow THROUGH the liver". Then, the next section is "Hepatic Venous Outflow Obstruction", where it goes on to list hepatic vein thrombosis and IVC thrombosis, etc. Not to mention, p.917 has a figure at the top that lists "systemic circulatory compromise" as Impaired INTRAhepatic blood flow.

So, as far as I can tell, depending on where you look Robbins seems to list it under both categories. So which is more widely accepted??

Disclaimer: It is very late right now, so if this doesn't make sense, you now know why (plus, I'm way too lazy to proofread). Peace.

 

[fakin' the funk]

"right-sided cardiac decompensation leading to congestion of the liver" and "left-sided cardiac failure/shock leading to hypoperfusion"..."Impaired blood flow THROUGH the liver"..."systemic circulatory compromise" as Impaired INTRAhepatic blood flow.
.

I think it may be important to distinguish that although those all can cause impaired blood flow through the liver, it is not a truly INTRAhepatic cause, if you take "intrahepatic" to mean "hepatocellular."

And nutmeg liver or no, none of those hemodynamic disturbances are the culprit in cirrhosis, which was the OP's point.