SN2 SHORT NOTE 5M ★ High-yield

Differentiate hyperaemia from congestion. Describe chronic venous congestion of the lung, liver and spleen.

Pathology · 2nd Professional — Para-Clinical

Definitions

Term	Definition	Mechanism
Hyperaemia	Increased blood in a tissue from active arteriolar dilatation	Active process
Congestion	Increased blood in a tissue from impaired venous outflow	Passive process

Feature	Hyperaemia	Congestion
Nature	Active	Passive
Cause	Arteriolar dilatation	Obstruction to venous drainage
Blood	Oxygenated — arterial	Deoxygenated — venous
Colour	Red (erythema)	Blue-red (cyanosis)
Temperature	Warm	Cool
Examples	Inflammation, exercise, blushing, flushing	Cardiac failure, deep vein thrombosis, portal hypertension
Outcome	Usually beneficial	Oedema, haemorrhage, hypoxia, fibrosis

Acute and Chronic Venous Congestion

Feature	Acute	Chronic
Onset	Sudden	Gradual, prolonged
Organ	Enlarged, tense, dark	Enlarged, firm, fibrotic
Microscopy	Dilated engorged vessels, sometimes with haemorrhage	Haemosiderin-laden macrophages, fibrosis, parenchymal atrophy

Chronic Venous Congestion of Specific Organs

Organ	Name	Features
Lung	Brown induration — in left ventricular failure and mitral stenosis	Thickened alveolar septa; "heart failure cells" — haemosiderin-laden macrophages in the alveoli; rusty sputum; fibrosis
Liver	"nutmeg" liver — in right ventricular failure and constrictive pericarditis	Centrilobular congestion and necrosis (dark) alternating with paler periportal fatty change; long-standing cases give "cardiac cirrhosis"
Spleen	Congestive splenomegaly — in portal hypertension	Firm and enlarged; GAMNA–GANDY bodies — fibrous nodules with haemosiderin and calcium
Lower limbs	Chronic venous insufficiency	Oedema, pigmentation, lipodermatosclerosis, venous ulceration

CLINICAL PEARL

The centre of the hepatic lobule is the first to suffer and the last to be relieved. It is furthest from the portal supply and nearest the central vein, so raised venous pressure and hypoxia both hit it first. This is why chronic congestion gives the mottled "nutmeg" pattern — dark congested centres against paler peripheries.

Consequences of Congestion

Oedema — raised hydrostatic pressure
Hypoxia and parenchymal atrophy or necrosis
Haemorrhage — rupture of engorged vessels, giving haemosiderin deposition
Fibrosis in long-standing cases
Increased risk of thrombosis from stasis

Applied Aspects

Rusty or blood-stained sputum with heart failure cells indicates chronic pulmonary congestion, most often from mitral stenosis — still common in India from rheumatic heart disease
Nutmeg liver with a pulsatile, tender hepatomegaly points to right heart failure or tricuspid regurgitation
Congestive splenomegaly in portal hypertension causes hypersplenism, with pancytopenia
Venous ulceration of the medial malleolus follows chronic venous insufficiency, and is managed by compression rather than by antibiotics
Hyperaemia of inflammation is protective, delivering leucocytes and mediators; congestion is never beneficial

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