Does pressure cause liver cirrhosis? The sinusoidal pressure hypothesis

Figure 8 Sinusoidal pressure hypothesis at the vascular level. Simplified scheme of the hepatic vascular architecture and conditions that result in elevated sinusoidal pressure (SP) and liver stiffness (LS). SP and LS are shown as consequence of the various inflow (red circles) and outflow balances (black circles) in a schematized vascular architecture of the liver. Intrahepatic or extrahepatic shunts (white circles) will also affect SP in a complex manner and, according to SPH, will also have an important impact on the development of portal hypertension and liver function. According to SPH, M1 (stiff livers with good liver function) and M2 (soft liver with poor liver function) can be postulated for patients with liver cirrhosis based on intrahepatic shunt formation. Red arrows: Flow direction; HABR: Hepatic arterial buffer response; SPH: Sinusoidal pressure hypothesis.