hello everyone welcome back to this short tutorial from pathology Made Simple at Isle of pathology.com in the last video we had learned about the chronic venous congestion of lung right so in this video in continuation with the chronic venous congestion topic which learn about chronic venous condition of liver and spleen so we will be understanding the pathogenesis the gross and microscopic features of both chronic venous condition liver and spleen so this is what we saw in the earlier uh video right so we looked into a various causes of left heart failure which leads to pulmonary venous condition and thereby chronic venous congestion of lung right similarly whenever you have a right heart failure and that pressure is transmitted Upstream of the right heart which leads to systemic venous condition leading on to chronic venous condition of the liver spleen and kidney so let's look into chronic venous condition of liver now so we all know that the hepatic veins empty into the vena cava immediately inferior to the heart right and thus liver is very vulnerable to both acute and chronic passive congestion so whenever there is right heart failure this increased pleasure you know in the central vein is directly transmitted to the sinusoids and thereby resulting in dilatation of sinusoids so let's understand this by uh this simple illustration so this is your central vein right so whenever there is congestion Whenever there is increased pressure in this Central vein obviously the pressure is transmitted into the hepatic sinusoids and then there will be dilatation of hepatic sinusoids so once there is validation and congestion of hepatic sinusoids there will be pressure atrophy of all these hepatocytes particularly in the centrilobular zone whereas the mid Zone hepatocytes it may show fatty change and that's because of relative hypoxia and the peripheral zone of the hepatic lobules are relatively spread so this is basically the pathogenesis and even the findings synchronic Venus condition of the liver so in long-standing cases what really happens is that there will be thickening of the central vein there will be sinusoidal thrombosis and the strain promote fibrosis which in extreme cases particularly in cases of conditions like constricted pericardities or tricuspid stenosis where there will be extreme right heart failure right extreme pressure transmitted into the central vein leading on to lots of fibrosis and finally bis fibrosis becomes generalized throughout the liver and resulting in cirrhosis and this type of cirrhosis is called as cardiac cirosis the name cardiac sirosis is basically because this serosis the origin of this xerosis is basically due to the cardiac failure particularly the right sided cardiac failure now you understood right we have earlier studied that alcoholism is the most common cause of cirrhosis right now we also looked into the stenosis now I'm sure you all know that this is a nutmeg why are we looking at nutmeg that's because the cut section of the chronic venous condition liver where you find dark spots and the palace Parts the dark spots are the ones which are areas representing the dilated and congested hepatic minerals whereas the paler Parts which are the normal areas around these congested manuals okay and this cut section is reminiscent of the cut section of nutmeg and hence this is also referred to as nutmeg liver okay not made liver basically it tells you that there is congestion in the center and then periphery appears normal another illustration showing very characteristic nutmeg appearance so that's a formal in fixed specimen showing a nutmeg appearance wherein the dark spots are basically located on congested hepatic manuals whereas the paler areas are normal looking areas or normal hepatocytes microscopically as we have studied earlier there will be Central vein which is dilated and congested it and that resulting in central hemorrhagic necrosis right the Hemorrhage necrosis is particularly more so around the century in between the central lobular zone around the central veins and you can find fatty change in the mid zonal hepatocytes peripheral zones as we all know it will be relatively normal and that's the portal so this is the characteristic microscopic feature of chronic venous congestion of liver now moving on to understanding another important organ affected by a red heart failure and systemic Finance condition that is chronic penis condition of this plane you know the most the most common causes of cervous plane is Right heart failure and of course portal hypertension where there will be increased intravascular pressure in the liver and that increased intravascular pressure in the liver we saw that's because of adult failure and second cause could be Port lipidation it could be intra-hepatic obstruction also and that leads to increased pressure in the splenic vein okay so more pressure is transmitted via the portal vein into the splenic vein thereby leading to congestion of the spleen in long-standing cases just like what we saw in CVC liver there will be fibrosis throughout the spleen that's diffuse splenic fibrosis sometimes you do find you know Iron containing fibrotic and calcified of okay of old hemorrhages and that's classically known as gamma Gandhi bodies we will look into what these are typically grossly this plane is enlarged it's firm and tense the capsule is very much thickened that surface you know it oozes dark bread microscopically this is an illustration of CVC spleen microscopy where you can see that the capsule is thickened and even the trabeculae are equal okay thickened capsule and trabeculae you can easily make out that there is congestion in the red pulp okay so these are the contents of the white pulp and the red pulp basically because these plenic sinusites which are congested you see old Hemorrhage along with fibrosis which are impregnated with iron pigment and calcium salts and these are as I told you they are gamma Gandhi bodies are Gandhi gamma bodies so what are these bodies these are basically small firm spiroidal or irregular Foci which are yellow brown brown or even rusted color they consists relatively dense fibrous tissue with collagenous fibers which are impregnated with iron pigment and calcium salts however they form the result from organization and scarring of sites where small perivascular hemorrhages would have occurred and these are Brandy gamma bodies another very good you know microscopic photograph of Randy gamma body this is another classical appearance of gamma Gandhi body and that's a special strain for iron Pearl strain demonstrating diffuse the position of iron in these gamma antibodies note that these gamma Gandhi bodies are not specific for chronic venous condition of the spleen alone they can also be seen in sickle cell anemia they can also be seen in hemochromatosis they can also be seen in other organs like in case of various cancers or various tumors like green cell carcinoma liver carcinoma pituitary adenoma certain forms of lymphomas Etc okay for your understanding just note that in chronic weakness condition you can find gamma gandibodies but it is not specific to CVC spleen alone right so that's all about CVC spleen and liver we did understand the pathogenesis the gross and microscopic pieces of both these entities right CBC liver and spleen so thank you for watching if you've liked this video hit the like button do comment don't forget to subscribe because I'll be coming out with many more such small interesting videos If you find this video useful please do share thank you