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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 .

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liver trauma

Liver Trauma

Mohamed. Hashim Milhim

4th year medstudent

An-najah national univ.

background
Background
  • Largest organ,
  • 2nd most common injured,
  • Blunt trauma most common
why the liver
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

mechanisms of injury
Mechanisms of injury:-
  • simple compression against ribs, spine,
  • ligamentous attachment to diaphragm and the posterior abdominal wall ,shear forces during deceleration injury.
slide7

Mechanisms of injury:-

  • High-velocity bullet injuries
    • burst injuries with distant contusions and parenchymal disruption.
    • Associations
slide8

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.
associations
Associations:
  • Isolated liver injury occurs in less than 50% of patients.
  • Blunt trauma 45% with spleen
  • Rib fracture  33% with Liver injury
injuries
Injuries
  • Parenchymal damage
  • Subcapsular hematoma
  • Laceration
  • Contusion
  • Hepatic vascular disruption
  • Bile duct injury
injuries1
Injuries
  • Mild injuries heal in 3 months.
  • Moderate injuries heal in 6 months.
  • Sever injuries in 9-15 months.
clinically
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.
labs radiology
Labs & Radiology
  • Elevated LFTs
  • DPL -- high sensitivity
  • CT scan is the diagnostic procedure of choice.
  • US.
  • MRI ??
angiography
Angiography
  • active bleeding
  • Transcatheter embolization
  • Embolization & stenting for fistulas.
ct scan
CT Scan
  • Localization.
  • monitor healing.
  • Grades 1-6
classification aast
Classification(AAST)

I-Subcapsular hematoma<1cm, superficial laceration<1cm deep.

gallbladder injuries
Gallbladder injuries…
  • Rare
  • Predisposing factors.
  • contusions, avulsions, lacerations or perforations.
management
Management
  • In the past VS now treatment of blunt liver injury trauma
  • 86% , 67%
  • CT scan diagnosis and follow up
management1
Management…
  • Remember associated injuries
  • Resuscitate
  • Assessment of injury

Spiral CT

Laparotomy

  • Treatment
management2
Management…
  • consider Cryoprecipitate, FFP
  • Rooftop incision
  • Control blood Loss
slide26
Suturing of Lacerations
  • Resection
  • Packing
  • Recurrent parenchymal bleeding transcatheter embolization