several mechanisms that create unbalance in the circulatory system and will cause hepatic injury
several mechanisms that create unbalance in the circulatory system and will cause hepatic injury. The main mechanism causing hepatic dysfunction due to heart dysfunction is either an increase in cardiac filling pressures or low cardiac output and impaired perfusion. An increase in the preload or central venous pressure due to right ventricular dysfunction may cause direct liver damage due to increasing retrograde pressure to the venous and capillaries into the liver. This generates an elevation in liver enzymes. The elevated pressure is transmitted from the right heart chambers (right ventricle and atrium) to the hepatic veins and sinusoids, leading to intrahepatic edema, decreased perfusion and oxygen diffusion, as well as hemorrhagic injury and modification on the hepatocyte architecture and atrophy with associated collagen deposition, and fibrosis to the hepatic veins and sinusoids.
Another mechanism that can cause hepatic injury, especially when the left side of the heart is affected, is impaired perfusion and tissue hypoxia from decreased cardiac output. This may be associated with acute hepatocellular necrosis with marked elevation of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactic dehydrogenase (LDH), and prolongation of coagulation studies as thrombin and prothrombin time