**A) Clinical diagnosis:**
Right-sided heart failure
Jaundice
Tender hepatomegaly
**B) Laboratory diagnosis:**
Unconjugated hyperbilirubinemia (total bilirubin < 3 mg/dL)
Elevated (usually < 2- to 3-fold) aminotransferases
Prolonged PT/INR
Ascitic fluid, if present, has a high albumin content (typically > 2.5 g/dL)
**C) Pathological diagnosis:**
Gross
Liver is larger and wet. Cut section shows congested red centers of hepatic lobules surrounded by pale coloured unaffected peripheral areas. This appearance is known as nut meg liver. In a long standing case of chronic venous congestion, there will be increased fibrosis, decreased liver size and parenchyma is divided into lobules and condition is known as cirrhosis of liver.
Microscopy
Central vein and sinusoids are distended with RBCs. Some areas of hemorrhage are present. When these RBCs are phagocytosed by macrophages, they are called siderophages. Central lobular necrosis due to central vein congestion is seen. Fatty change is due to hypoxia in peripheral hepatocytes is also seen.
