51. Nutmeg liver: definition of the concept, causes, pathogenesis. Macro- and microscopic changes in the liver, outcomes, clinical significance.

Prolonged venous stagnation in the liver in severe chronic right ventricular insufficiency can lead to damage to hepatocytes and the development of cirrhosis of the liver.

Pathological anatomy and pathogenesis

Right ventricular failure leads to increased pressure in the inferior vena cava and hepatic veins and stagnation of blood in the liver. At the same time, the sinusoids are expanded and overflowing with blood, the liver is enlarged, its capsule is tense. Prolonged venous stasis and ischemia associated with low cardiac output lead to centrolobular necrosis. As a result, centrolobular fibrosis develops; connective tissue partitions radiate from the central veins towards the portal tracts like rays. The alternation of red areas of venous congestion and pale areas of fibrosis creates a characteristic picture of the "muscat liver" on the incision. Thanks to the successes of modern cardiology, and especially cardiac surgery, cardiac cirrhosis of the liver is now much less common than before.

52. Bleeding, hemorrhage: definition of concepts, types, mechanisms. Examples of diseases depending on the mechanism of development. Outcomes, clinical significance.

Bleeding is the release of blood outside the vascular bed or heart into the environment (external bleeding) or into the body cavity, the lumen of a hollow organ (internal bleeding). Examples of external bleeding are metrorrhagia (uterine), melena (intestinal), and internal bleeding are hemopericardium, hemothorax, hemoperitoneum and hemarthrosis (into the pericardium, pleura, abdominal cavity or joint, respectively). Depending on the source of bleeding, they are divided into arterial, arterial-venous (mixed), capillary, parenchymal (capillary from parenchymal organs) and cardiac.

A particular type of bleeding is hemorrhage, in which blood accumulates extravascularly in the tissues. There are four types of it:

hematoma is a hemorrhage with a violation of the integrity of tissues and the formation of a cavity;

hemorrhagic impregnation (infiltration) – hemorrhage while preserving the integrity of the tissue;

bruise (bruise) is a planar hemorrhage in the skin, subcutaneous tissue, and mucous membranes;

Petechiae are spot hemorrhages in the skin, mucous membranes and serous membranes, and internal organs. The mechanisms of development of both bleeding and hemorrhage include:

1. rupture resulting from injuries to an unchanged vessel or necrosis (rupture of the heart in myocardial infarction), inflammation (syphilitic mesaortitis with rupture of the aorta), aneurysms of the affected vascular wall;

2. corroding, or erosive bleeding, which develops when the vascular wall is destroyed by inflammation, malignant tumor, necrosis;

3.diapedesis, characterized by blood output due to increased vascular permeability, as a rule, of preserved vessels of the microcirculatory bed in severe hypoxia, intoxication, infection, various coagulopathies, hemorrhagic diathesis. Diapedesis hemorrhages often develop in hypertensive crisis, systemic vasculitis, leukemia, nemophilia, uremia