title: Hagen-Poiseuille's law: The link between cirrhosis, liver stiffness, portal hypertension and hepatic decompensation.
abstract: The onset of hepatic decompensation in cirrhosis heralds an accelerated downhill course with poor outcome. The sole predictor of this decompensation in cirrhosis is increased hepatic vein to portal vein gradient hepatic venous pressure gradient (HVPG). Surrogate markers of liver function or hepatic reserve appear to be less relevant. The hepatic sinusoids become less elastic and more rigid as liver fibrosis and cirrhosis progress. We propose that the Hagen-Poiseuille's law, which applies to rigid, but not elastic vessels, determines the pressure-flow characteristics in the sinusoids. In the rigid cirrhotic liver, HVPG rises dramatically with any change in net surface area or radius, r(4) of the vasculature that follows surgical resection. This review relates liver stiffness to the risk of decompensation in patients with cirrhosis. The liver has a unique dual blood supply comprising a low pressure portal vein and high pressure hepatic artery. We compare the complexity of autoregulation in the normal elastic liver with that in the rigid cirrhotic liver. Therapeutic modalities to reduce portal pressure may reduce the risk of hepatic decompensation and improve outcomes in cirrhosis.
authors.affiliation: Gerond Lake-Bakaar, Muneeb Ahmed, Amy Evenson, Alan Bonder, Salomao Faintuch, Vinay Sundaram, Liver Tumor Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Gerond
authors.initials: G
authors.lastname: Lake-Bakaar
authors.affiliation: Gerond Lake-Bakaar, Muneeb Ahmed, Amy Evenson, Alan Bonder, Salomao Faintuch, Vinay Sundaram, Liver Tumor Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Gerond Lake-Bakaar, Muneeb Ahmed, Amy Evenson, Alan Bonder, Salomao Faintuch, Vinay Sundaram, Liver Tumor Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: Evenson
authors.affiliation: Gerond Lake-Bakaar, Muneeb Ahmed, Amy Evenson, Alan Bonder, Salomao Faintuch, Vinay Sundaram, Liver Tumor Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Alan
authors.initials: A
authors.lastname: Bonder
authors.affiliation: Gerond Lake-Bakaar, Muneeb Ahmed, Amy Evenson, Alan Bonder, Salomao Faintuch, Vinay Sundaram, Liver Tumor Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Salomao
authors.initials: S
authors.lastname: Faintuch
authors.affiliation: Gerond Lake-Bakaar, Muneeb Ahmed, Amy Evenson, Alan Bonder, Salomao Faintuch, Vinay Sundaram, Liver Tumor Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sundaram
keywords: Hagen-Poiseuille’s law; Liver stiffness; Portal hypertension