Definition: HVPG

The HVPG (hepatic vein-portal pressure gradient, measured by an interventional radiologist) is arguably the best marker of end-stage liver disease severity.  As the fibrotic liver increases the pressure gradient between the portal and systemic circulatory systems, you begin to see complications like ascites, variceal bleeding and even hepatocellular carcinoma.

Here is a schematic of the HVPG measurement; the gradient is determined by the difference between the free hepatic vein pressure and the wedged hepatic vein pressure (the latter an indirect method of determining a pre-sinusoidal portal pressure, akin to a right heart catheterization measurement of left-sided heart pressures). 

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