HEPATIC VENOUS PRESSURE GRADIENT DOWNLOAD!
Portal hypertension is key to the natural history of cirrhosis and the standard way to assess it is the hepatic venous pressure gradient. Hepatic venous pressure. Jump to Hepatic venous pressure gradient (HVPG) - Hepatic venous pressure gradient (HVPG) HVPG is a clinical measurement of the pressure gradient between the WHVP and the free hepatic venous pressures, and thus is an estimate of the pressure gradient between the portal vein and the inferior vena cava. Measurement of the Hepatic Venous Pressure Gradient (HVPG).
|Published:||25 September 2016|
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HVPG hepatic venous pressure gradient has evolved from being mainly used with diagnostic purposes to be considered a useful tool to assess the severity and prognosis of chronic liver disease and LC, including the risk of the complications such as varices bleeding, ascites, encephalopathy, or hepatorenal syndrome.
This new classification is necessary for overcoming the limitation of prematurely concluding cirrhosis as an end-stage of chronic liver diseases.
This new hepatic venous pressure gradient classified the distinction between compensation and decompensation which is mainly defined by clinical outcome Table 1. Ripoll et al 20 found that HVPG greater than 10 mmHg predicts the likelihood of developing decompensation.
Within the compensated stage, patients can hepatic venous pressure gradient sub-classified into those without varices stage 1 and those with varices stage 2.
Compensated LC is classified based on the absence or the presence of varices and the risk of death is low. In LC, the inter-sinusoidal communications are blocked by fibrous tissue, dissipation of pressure in the wedged vessels is insignificant and the WHVP accurately estimates portal pressure.
Patients who have severe cardiopulmonary disease, encephalopathy, or hypersensitivity to contrast dye are contraindicated in HVPG measurement. HVPG represents the gradient between pressures in the portal vein and the intra-abdominal portion of inferior vena cava.
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When blood flow in a hepatic vein is stopped by a wedged catheter, the proximal static column of blood transmits the pressure from the preceding communicated vascular territory hepatic sinusoids to the catheter.
Thus, WHVP reflects hepatic sinusoidal pressure and not the portal pressure itself. In the normal liver, due to pressure equilibration through interconnected sinusoids, wedged pressure is slightly lower than portal pressure, though this difference is clinically insignificant.
In patients with cirrhotic livers intersinusoidal communication is disrupted such that sinusoidal pressure equilibrium cannot be maintained, and so WHVP becomes a far more accurate measure hepatic venous pressure gradient portal venous pressure.