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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 .

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Liver Trauma

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  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

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