Why is nutmeg liver associated with chronic hepatic congestion, not acute?

[Ven0m]

Is it because in acute, there is not enough time for peripheral hepatocytes (those near the arterioles within each hepatic lobule) to undergo fatty change (steatosis), while in chronic, they had enough time to fatty change?

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[amberkre]

Nutmeg liver is the appearance of the liver due to areas of white and areas of red/brown (speckled appearance of the liver). The red/brown parts are from chronic accumulation of RBCs (chronic congestion) surrounding the hepatic veins (in the central parts of the lobule). The white areas are actually from pericentral hepatocytes that are ischemic (starved of o2 over time b/c of the chronic congestion they are not getting enough oxygenated blood since the RBCs close by are deoxygenated and theres a backup of blood flow). I think the chronic congestion is necessary to cause the ischemia of the pericentral hepatocytes. I could be wrong since my source is mostly wikipedia but it makes sense i think!

 

[Ven0m]

Oh okay, so there's no ischemic necrosis (coagulative) on the gross view of acute hepatic congestion since time wasn't enough I guess? Thanks for pointing out that the pale areas of nutmeg are necrosed central hepatocytes, I mistakenly thought they were peripheral hepatocytes undergoing fatty change.

 

[amberkre]

yeah to my knowledge its all about the duration of the congestion... chronic congestion with nutmeg should make you think of right sided heart failure typically (left siding causing the right sided usually).

hepatic steatosis (fatty liver) is usually with chronic alcoholics or the nonalcoholic subtype which is from metabolic syndrome

 

[Ven0m]

Cool, thanks amber.