Portal venous pressure

Portal venous pressure is the blood pressure in the hepatic portal vein, and is normally between 5-10 mmHg.^[1] Raised portal venous pressure is termed portal hypertension,^[2] and has numerous sequelae such as ascites and hepatic encephalopathy.^[3]^[4]

Wedged hepatic venous pressure (WHVP)

WHVP is used to estimate the portal venous pressure by reflecting not the actual hepatic portal vein pressure but the hepatic sinusoidal pressure. It is determined by wedging a catheter in a hepatic vein, to occlude it, and then measuring the pressure of proximal static blood (which is reflective of pressure in the sinusoids). WHVP in fact slightly underestimates portal pressure due to sinusoidal equilibration in patients without cirrhosis, but the difference between the two 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 of portal venous pressure.

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. An HVPG of ≥10 mmHg defines clinically significant portal hypertension, and if the measurement exceeds 12 mmHg variceal haemorrhaging may occur.^[5] While not widely performed, its assessment in people with chronic liver disease is recommended to monitor response to treatment.^[6]

References

↑ eMedicine - "Esophageal Varices"
↑ Ascites in Cirrhosis Relative Importance of Portal Hypertension and Hypoalbuminemia DONALI) O. CASTELL, LCDR (MC), USN
↑ "Portal Hypertension.". Postgrad Med J 23 (264): 451–68. Oct 1947. doi:10.1136/pgmj.23.264.451-a. PMID 21313474.
↑ Sauerbruch, T.; Trebicka, J. (2014). "Future therapy of portal hypertension in liver cirrhosis - a guess.". F1000Prime Rep 6: 95. doi:10.12703/P6-95. PMID 25374673.
↑ Kumar, A.; Sharma, P.; Sarin, S. K. (2008). "Hepatic venous pressure gradient measurement: Time to learn!". Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 27 (2): 74–80. PMID 18695309.
↑ Triantos, C. K.; Nikolopoulou, V.; Burroughs, A. K. (2008). "Review article: The therapeutic and prognostic benefit of portal pressure reduction in cirrhosis". Alimentary Pharmacology & Therapeutics 28 (8): 943–952. doi:10.1111/j.1365-2036.2008.03798.x. PMID 18627364.

External links

Portal Pressure at the US National Library of Medicine Medical Subject Headings (MeSH)

Physiology of the cardiovascular system

Heart

Cardiac output	Cardiac cycle Cardiac output Heart rate Stroke volume Stroke volume End-diastolic volume End-systolic volume Afterload Preload Frank–Starling law of the heart Cardiac function curve Venous return curve Wiggers diagram Pressure volume diagram

Ultrasound	Fractional shortening = (End-diastolic dimension End-systolic dimension) / End-diastolic dimension Aortic valve area calculation Ejection fraction Cardiac index

Heart rate	Cardiac pacemaker Chronotropic (Heart rate) Dromotropic (Conduction velocity) Inotropic (Contractility) Bathmotropic (Excitability) Lusitropic (Relaxation)

Conduction	Conduction system Cardiac electrophysiology Action potential cardiac atrial ventricular Effective refractory period Pacemaker potential Electrocardiography P wave PR interval QRS complex QT interval ST segment T wave U wave Hexaxial reference system

Chamber pressure	Central venous Right atrial ventricular pulmonary artery wedge Left atrial ventricular Aortic

Other	Ventricular remodeling

Vascular system/
Hemodynamics

Blood flow	Compliance Vascular resistance Pulse Perfusion

Blood pressure	Pulse pressure Systolic Diastolic Mean arterial pressure Jugular venous pressure Portal venous pressure

Regulation of BP	Baroreflex Kinin–kallikrein system Renin–angiotensin system Vasoconstrictors Vasodilators Autoregulation Myogenic mechanism Tubuloglomerular feedback Cerebral autoregulation Paraganglia Aortic body Carotid body Glomus cell

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