Pulmonary vascular complications in portal hypertension and liver disease: a concise review

Chronic liver disease and/or portal hypertension may be associated with one of the two pulmonary vascular complications: portopulmonary hypertension and hepatopulmonary syndrome. These pulmonary vascular disorders are notoriously underdiagnosed; however, they have a substantial negative impact on survival and require special attention in order to understand their diagnostic approach and to select the best therapeutic options. Portopulmonary hypertension results from excessive vasoconstriction, vascular remodeling, and proliferative and thrombotic events within the pulmonary circulation that lead to progressive right ventricular failure and ultimately to death. On the other hand, abnormal intrapulmonary vascular dilations, profound hypoxemia, and a wide alveolar-arterial gradient are the hallmarks of the hepatopulmonary syndrome, resulting in difficult-to-treat hypoxemia. The aim of this review is to summarize the latest pathophysiologic concepts, diagnostic approach, therapy, and prognosis of portopulmonary hypertension and hepatopulmonary syndrome, as well as to discuss the role of liver transplantation as a definitive therapy in selected patients with these conditions.

[Severe acute pancreatitis: prognosis and treatment implications]

Severe acute pancreatitis (SAP) is a very important cause of morbi-mortality inside the context of gastrointestinal diseases, and there is still some controversy in important points regarding its medical and surgical management. The present review article assesses and compares the results and conclusions of several clinical trials with respect the staging of severity, supportive measurements, prophylactic antibiotics, surgical treatment of infected and sterile necrosis and the implications that such studies have in the prognosis and management of SAP. Endoscopic techniques of treatment are beyond the scope in this review.