Cardiac Cirrhosis and Congestive Hepatopathy Differential Diagnoses

Updated: Dec 22, 2014
  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Diagnostic Considerations

Important considerations include the following:

  • Diagnose a correctable underlying cause of cardiac cirrhosis . For example, patients with alcoholism and cardiac disease who present with ascites may be misdiagnosed by attributing liver derangements to alcoholic cirrhosis.
  • Search for concomitant hepatobiliary disease in patients with either significantly or persistently elevated hepatic transaminases, alkaline phosphatase, or total bilirubin levels. For example, collecting a detailed social history may lead to the diagnosis of acute hepatitis B infection and prevent progression to end-stage liver failure.
  • Do not perform unnecessary liver biopsies.
  • Transjugular intrahepatic portosystemic shunt (TIPSS) is contraindicated in cardiac cirrhosis. It may precipitate acute right heart failure from an acute increase in pulmonary arterial pressure.
  • Adjust hepatically cleared medications.

Other conditions to consider in patients with cardiac cirrhosis and congestive hepatopathy include the following:

  • Biventricular congestive heart failure
  • Rright ventricular congestive heart failure
  • Hepatic veno-occlusive disease
  • Ischemic hepatitis

Differential Diagnoses