The Correlation of spleen stiffness Measured by Acoustic Radiation Force Impulse Imaging (ARFI) with Hepatic Venous Pressure Gradient (HVPG) in the prediction of grade of esophageal varices in cirrhotic patients / Mohammed Ragab Sayed Abdelwahab ; Supervised Ayman Yosry Abdelrahim , Maged Tharwat Elghannam , Ahmed Mohammed Khairy

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Tropical Medicine

Portal hypertension (PH), a major hallmark of cirrhosis, is a pathologic increase in the portal venous pressure gradient between the portal vein (PV) and the inferior vena cava (IVC) (Garcia-Tsao, 2006). Portal pressure is most commonly determined by the hepatic vein pressure gradient (HVPG), which is the difference between the wedged hepatic venous pressure (WHVP) (reflecting the hepatic sinusoidal pressure) and free hepatic vein pressure (FHVP) (Garcia-Pagan et al., 2005). It has been demonstrated that a HVPG value higher than 10mmHg predicts the presence of esophageal varices (EVs), while a value higher than 12mmHg is predictive for variceal bleeding. However, the evaluation of HVPG is an invasive procedure, which is limited to highly specialized centers and experienced operators (Bosch et al., 2006). EVs resulting from PH are present in approximately 50 % of patients with cirrhosis (Garcia-Tsao et al., 2007), and variceal bleeding is life-threatening with a 14 % mortality for hospitalized patients (Carbonell et al., 2004)

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