Wedged hepatic venous pressure (WHVP) is measured by inflating a balloon at the catheter tip, thus occluding a hepatic vein branch. Measurement of the WHVP provides a close approximation of portal pressure.ย
The HVPG is defined as the difference in pressure between the portal vein and the inferior vena cava. Thus, the HVPG is equal to the WHVP value minus the FHVP value (ie, HVPG = WHVP - FHVP). The normal HVPG is 3-6 mm Hg.
5mmHg Here-->NO cirrhosis
an_improved_meIn general though, i don't think you need to know that... I think the important things are that:
tells you there is widening of hepatic venules (which one can imagine is due to increased pressure)
tells you that hepatic wedge pressure (estimate of portal pressure) is 30; portal pressure should be less than 5.
therefore, elevated portal pressure in the absence of RA pressure indicates obstruction before the heart (in this case, budd chiari).
Compare that to cardiac cirrhosis, which would have increased RA pressures AND increased portal venous pressures.
+2
an_improved_meShit, and finally, since there are only mild increases in billi, AlkPhos, AST/ALT, i think that rules out cirrhosis. +1
an_improved_meAdd the fact that he doesn't have risk factors for cirrhosis (no drinking, smoking cigs, [would have loved to see a negative serology panel...], i think that also brings cirrhosis further down on your DDx+1
an_improved_meAdd the fact that he doesn't have risk factors for cirrhosis (no drinking, smoking cigs, [would have loved to see a negative serology panel...], i think that also brings cirrhosis further down on your DDx+1
an1I had it down to the 2 options too. and I went with hepatic venues because I know that's related to BC more than it is to cirrhosis per say. But another way to approach this could be that due to renal removal, he may be taking exogenous EPO, which can lead to thrombosis (often seen with poly vera; which also happen to be ht eMCC of BC)+
submitted by โlinfeng(1)
Wedged hepatic venous pressure (WHVP) is measured by inflating a balloon at the catheter tip, thus occluding a hepatic vein branch. Measurement of the WHVP provides a close approximation of portal pressure.ย The HVPG is defined as the difference in pressure between the portal vein and the inferior vena cava. Thus, the HVPG is equal to the WHVP value minus the FHVP value (ie, HVPG = WHVP - FHVP). The normal HVPG is 3-6 mm Hg. 5mmHg Here-->NO cirrhosis