Pathology MCQ5

Pathology MCQ5:
A 58-year-old man with pulmonary emphysema has a 10 year history of congestive heart failure. On physical examination, he has lower leg swelling with grade 2 pitting edema
to the knees and prominent jugular venous distention to the level of the mandible. His serum levels of AST and ALT are increased. The representative gross appearance of his liver is
shown in the figure. Which of the following underlying conditions is most likely to be present in this man?

A Chronic renal failure
B Common bile duct obstruction
C Congestive heart failure
D Portal vein thrombosis
E Thrombocytopenia

Explanation:
The figure shows a so-called nutmeg liver caused by chronic passive congestion from congestive heart failure. The elevated enzyme levels suggest that the process is so severe
that hepatic centrilobular necrosis has also occurred.

The physical findings suggest right-sided heart failure that can occur with pulmonary emphysema and pulmonary arterial hypertension.
Biliary tract obstruction would produce bile stasis (cholestasis) with icterus.
Hepatic congestion is not directly related to renal failure, and hepatorenal syndrome has no characteristic gross appearance.
A portal vein thrombus would diminish blood flow to the liver, but it would not be likely to cause necrosis because of that organ’s dual blood supply. The regular pattern of red lobular discoloration seen in the figure is unlikely to occur in hemorrhage from throm-
bocytopenia, characterized by petechiae and ecchymoses.
So, the correct option is C(Congestive heart failure).
 (Image credit:researchgate.net, National toxicology programme)
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