Key messages

• Therapy is determined by diagnosis; an accurate history and careful sequence of investigations are crucial.

• Once hemolysis is excluded, an ultrasound scan is the most important diagnostic modality.

• A therapeutic endoscopic retrograde cholangiopancreatography is indicated in selected cases with severe acute pancreatitis and/or cholangitis.

• Rigorous attempts must be made to identify occult sepsis.

• Attempts to improve splanchnic blood flow using dopexamine hydrochloride are logical, and may reduce morbidity and mortality in sick presurgical cases.

• Although dopexamine hydrochloride may improve splanchnic hemodynamics and hepatic oxidative capacity in patients with multiple systems organ failure, there is no evidence yet of survival benefit.

• Experimental studies inhibiting inflammatory mediators underlying hepatic dysfunction in multiple systems organ failure have not yet been translated into clinical trials.

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