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Sinusoidal Pressure Hypothesis – Hemodynamic Level

At the hemodynamic level, liver stiffness provides a measurable readout of pressure changes across the hepatic vascular bed.

The liver is normally a low-pressure organ. Venous congestion raises sinusoidal pressure directly, while increased arterial inflow can also increase stiffness. In advanced fibrosis and cirrhosis, vascular remodeling and progressive arterialization may expose the liver to a sustained pressure load and reinforce the fibrotic process.

This hemodynamic view explains why congestion can mimic severe fibrosis on elastography and why stiffness may change rapidly when circulatory conditions change.

Hemodynamic framework linking hepatic inflow, outflow, sinusoidal pressure and liver stiffness.

Selected publications

• Liver stiffness is directly influenced by central venous pressure. Millonig G et al. J Hepatol. 2010;52(2):206–210.
• Arterial pressure suffices to increase liver stiffness. Piecha F et al. Am J Physiol Gastrointest Liver Physiol. 2016;311(5):G945–G953.
• Does pressure cause liver cirrhosis? The sinusoidal pressure hypothesis. Mueller S. World J Gastroenterol. 2016;22(48):10482–10501.