[Respiratory-failure and Severe Acute-pancreatitis]

The two basic mechanisms underlying most of the pleuropulmonary complications of severe acute pancreatitis include pulmonary atelectasis and alveolar flooding. Like in any abdominal catastrophy, pleural effusion and limited diaphragmatic excursion due to pain and intestinal atony are the main factors responsible for alveolar collaps and secondary infection. Physical therapy and needle pleural evacuation are the cornerstones of management. Owing to its pathophysiologic mechanisms adult respiratory distress syndrome is peculiar to acute pancreatitis. Alveolar capillary membrane injury is related to pancreatic necrosis, to its regional extent and to the subsequent overamplification of the inflammatory reaction. Diversion of those potential mediators of the syndrome either surgically or by thoracic duct drainage is essential in order to improve survival in these patients

Sequential treatment of hepatorenal syndrome and posthepatic cirrhosis by intrahepatic portosystemic shunt (TIPSS) and liver transplantation

The results of liver transplantation are compromised in cirrhotic patients presenting with renal insufficiency from hepatorenal syndrome. A case of cirrhosis and hepatorenal syndrome, treated sequentially with transjugular intrahepatic porto-systemic stent shunting (TIPSS) and Liver transplantation, is discussed. TIPSS may be useful for correcting renal dysfunction and/or hepatorenal syndrome in. end-stage cirrhotics, thus permitting subsequent elective Liver transplantation under good conditions