Liver disease, from heart or...?

Question

Now I wish I had taken a recorder to the citology course.

The teacher said it was possible to recognise - cytologically - a liver disease originated from the heart, because the most damaged cells were nearer to the centrolobular vein, from a disease of another origin... and I never caught the rest. Twelve years later, I'm still curious. What was he talking about?

Answer 1

As you know, the liver has two blood supplies (hepatic artery and portal vein), and one "drainage" (hepatic vein).

You can see from the diagram below, within a liver lobule, some liver cells are closer to the centre (where the centrilobular vein is), while others are nearer the "edge", where the bile ducts are.

http://www.livercancer.com/images/lobule...

When a person is in congestive heart failure, the heart isn't able to pump blood out as efficiently, so some blood gets "left behind", and the pressure in the heart rises.  This pressure then backs up into the inferior vena cava, then into the hepatic veins, and eventually to the centrilobular veins, affecting the liver cells around them.

To quote Rubin's (one of the most used pathology textbook): "The hepatic vein empties into the vena cava immedicately inferior to the heart, so the liver is particularly vulnerable to acute or chronic passive congestion.  The central veins of hepatic lobules become dilated.  The increased venous pressure is transmitted to the sinusoids, which dilate, and centrilobular hepatocytes undergo pressure atrophy."

http://books.google.ca/books?id=kD9VZ267...

Problems from other sources, like a gallstone causing bile blockage, will cause bile to backup the bile ducts, affecting the liver cells around the bile ducts.  

So through cytological/pathological examination, one can tell if the liver problem is caused by something from the heart or elsewhere.

Hope this helps.