Hepatic And Biliary Disorders Chapter 46. In acute heart failure and shock, ischemic liver changes are common. Inflammation is usually modest, and the lobular architecture is retained. Circulatory collapse or congestive failure is the dominant clinical feature. With chronic heart failure, the liver is usually firm.
Fibrosis is common, but cirrhosis is rare.
Its pathogenesis requires repeated, prolonged episodes of heart failure. Congestion and loss of hepatocytes are seen. Zone 3 bridging of the necrotic areas develops in severe cases. Therapy is directed toward the underlying heart disease. Thrombi obstruct the sinusoids, especially in zone 3, and lead to sinusoidal congestion and focal necrosis.