A 76-year-old man with dyspnea and signs of congestive heart failure would most likely have which abdominal finding due to hepatic congestion?

A 76-year-old man with dyspnea and signs of congestive heart failure would most likely have which abdominal finding due to hepatic congestion?

• A. Periumbilical Ecchymoses
• B. Murphy's Sign
• C. Hepatomegaly
• D. Absent Bowel Sounds

Answer: (C)

Elevated right-sided heart pressures in congestive heart failure cause blood to back up into the hepatic veins, leading to passive congestion of the liver. This results in hepatomegaly, a classic abdominal finding in CHF, because the liver becomes enlarged from the increased venous inflow and swelling of the hepatic tissue. In acute decompensation the liver may be tender, and with chronic passive congestion the liver can take on a nutmeg-like appearance with congestion-related changes and possible ascites. Periumbilical ecchymosis would point more toward intra-abdominal bleeding or pancreatitis-related signs, not hepatic congestion. Murphy’s sign indicates gallbladder inflammation, not venous congestion of the liver. Absent bowel sounds suggest ileus or peritonitis, which aren’t primary features of hepatic congestion in heart failure.

Elevated right-sided heart pressures in congestive heart failure cause blood to back up into the hepatic veins, leading to passive congestion of the liver. This results in hepatomegaly, a classic abdominal finding in CHF, because the liver becomes enlarged from the increased venous inflow and swelling of the hepatic tissue. In acute decompensation the liver may be tender, and with chronic passive congestion the liver can take on a nutmeg-like appearance with congestion-related changes and possible ascites.

Periumbilical ecchymosis would point more toward intra-abdominal bleeding or pancreatitis-related signs, not hepatic congestion. Murphy’s sign indicates gallbladder inflammation, not venous congestion of the liver. Absent bowel sounds suggest ileus or peritonitis, which aren’t primary features of hepatic congestion in heart failure.