1 / 27

Liver Trauma

Liver Trauma . Mohamed. Hashim Milhim 4th year medstudent An-najah national univ. Background. Largest organ, 2nd most common injured, Blunt trauma most common. Why the liver…. Friable parenchyma, thin capsule, fixed position in relation to spine  prone to blunt injury .

lave
Télécharger la présentation

Liver Trauma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Liver Trauma Mohamed. Hashim Milhim 4th year medstudent An-najah national univ.

  2. Background • Largest organ, • 2nd most common injured, • Blunt trauma most common

  3. Why the liver… • Friable parenchyma, thin capsule, fixed position in relation to spine  prone to blunt injury . • Right lobe larger, closer to ribs. more injury • In children compliant ribs, transmitted force

  4. Mechanisms of injury:- • simple compression against ribs, spine, • ligamentous attachment to diaphragm and the posterior abdominal wall ,shear forces during deceleration injury.

  5. Mechanisms of injury:- • High-velocity bullet injuries • burst injuries with distant contusions and parenchymal disruption. • Associations

  6. Mechanisms of injury:- Low-velocity penetrating injury • Stab wounds • percutaneous biopsy • cholangiography • biliary drainage, • (TIPS), • capsular tears, hematoma, bile leaks, arteriobiliary fistulas, and hemoperitoneum, arterial aneurysms.

  7. Associations: • Isolated liver injury occurs in less than 50% of patients. • Blunt trauma 45% with spleen • Rib fracture  33% with Liver injury

  8. Injuries • Parenchymal damage • Subcapsular hematoma • Laceration • Contusion • Hepatic vascular disruption • Bile duct injury

  9. Injuries • Mild injuries heal in 3 months. • Moderate injuries heal in 6 months. • Sever injuries in 9-15 months.

  10. Clinically • Symptoms & signs of injury are • blood loss, • peritoneal irritation, • RUQ tenderness, and guarding. • delayed abscess . • Signs of blood loss may dominate the picture. • Biliary peritonitis.

  11. Labs & Radiology • Elevated LFTs • DPL -- high sensitivity • CT scan is the diagnostic procedure of choice. • US. • MRI ??

  12. Angiography • active bleeding • Transcatheter embolization • Embolization & stenting for fistulas.

  13. CT Scan • Localization. • monitor healing. • Grades 1-6

  14. Classification(AAST) I-Subcapsular hematoma<1cm, superficial laceration<1cm deep.

  15. II-Parenchymal laceration 1-3cm deep, subcapsular hematoma1-3 cm thick.

  16. III-Parenchymal laceration> 3cm deep and subcapsular hematoma> 3cm diameter.

  17. IV-Parenchymal/supcapsular hematoma> 10cm in diameter, lobar destruction,

  18. V- Global destruction or devascularization of the liver.

  19. VI-Hepatic avulsion

  20. Gallbladder injuries… • Rare • Predisposing factors. • contusions, avulsions, lacerations or perforations.

  21. Management • In the past VS now treatment of blunt liver injury trauma • 86% , 67% • CT scan diagnosis and follow up

  22. Management… • Remember associated injuries • Resuscitate • Assessment of injury Spiral CT Laparotomy • Treatment

  23. Management… • consider Cryoprecipitate, FFP • Rooftop incision • Control blood Loss

  24. Suturing of Lacerations • Resection • Packing • Recurrent parenchymal bleeding transcatheter embolization

  25. Thank you

More Related