Liver trauma




Portal triad
Blood supply


Liver trauma is divided into:
  • Blunt and
  • Penetrating injuries
  • Blunt injury produces contusion, laceration and avulsion injury.
  • Penetrating injuries (like stab and gunshot wounds are often associated with chest or pericardial involvement.

Blunt force-liver injury
Penetrating injuries

Clinical features
  • Features of shock due to severe bleeding.(pallor, hypotension, tachycardia, sweating)
  • Distension of abdomen with dull flank, guarding, tenderness and rigidity.
  • Oliguria
  • Tachypnoea, respiratory distress and often cyanosis.
  • Rupture of right lobe is more common than the left lobe leading to haemoperitoneum.
  • Occasionally can cause localised hematoma which may form an abscess.
  • Bile leak from the injured site can lead to biliary peritonitis.

Investigations
  • Chest X-ray to look for the rib fracture.
  • USG abdomen
  • CT scan of chest and abdomen
  • Diagnostic peritoneal lavage
  • Hb%, PCV, blood groouping and cross matching.
  • Arterial blood gas analysis (ABG)
  • Coagulation profile.

Treatment :

General measures

Maintain airway
Breathing
Circulation-
  • I.V fluids, blood transfusion (massive), FFP
  • Have both central and peripheral venous access.
  • Bladder catheterization to measure the urine output

Specific treatment
  • Laparotomy is done through a large abdominal incision or thoracoabdominal incision, and extent of liver injury and also other associated injuries are looked for.
  • Small liver tear is sutured with absorbable sutures with placing of gel foam to control bleeding.
  • To control intraoperative bleeding, from hepatic artery and portal vein, both are temporarily occluded using fingers, compressing at foramen of Winslow. Often bull-dog clamp or vascular clamps can be used.
  • In deep severe injuries, following methods are used:
  1. Hepatic artery ligation
  2. Segmental resection
  3. Hemihepatectomy
  4. Packing the liver temporarily with mops.
  • Cholecystectomy and placement of “T” tube in CBD
  • In associated IVC injuries , it is very difficult to manage. A veno-venous bypass between femoral vein  and SVC is done and then repair of IVC is carried out.
  • ICT placement to thorax and repair of diaphragmatic injury.

Post operatively patients require:
  • Ventilator support
  • Blood transfusion
  • Electrolyte management
  • Antibiotics
  • FFP, cryoprecipitate

Complications and Sequelae of liver injury
  • Shock and haemorrhage
  • Intrahepatic haematoma
  • Liver abscess and septicaemia
  • Bile leak, biliary peritonitis, biliary fistulas
  • Disseminated intravascular coagulation
  • Hepatic artery aneurysm
  • Arterio-venous fistula
  • Arterio-biliary fistula
  • Electrolyte imbalance
  • Liver failure
  • Late sequelae
  • CBD stricture

4 comments:

  1. Sometimes, our pet may suffer from different kind of harmful diseases. Phobias, allergies and seizures are main of those. Also cancer is the biggest issue for our pets. So, if we can use cbd dog treats for their better health then it will be much better for us. Because when our dogs can live a good life our face will always smile.

    ReplyDelete
  2. This comment has been removed by the author.

    ReplyDelete
  3. UV GULLAS COLLEGE OF MEDICINE is one of Top Medical College in Philippines in Cebu city. International students have the oppertunity to study medicine in phillipines at affordable cost and world class University. The college has successful alumni who have achieved well in the fields of law, business, politics, academe, medicine, sports and other endeavors. At University of the Visayas, we prepare students for a global competition.

    Direct MBBS Admissions Open: 2020-21
    Mobile No: +91 90329 55688
    Apply Now: https://www.careerplus.org.in/philippines-medical-college/uv-gullas-college-of-medicine

    ReplyDelete

Popular Posts