Liver TraumaLiver 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 . Right lobe larger, closer to ribs.

more injury In children

compliant ribs,

transmitted force

simple compression against ribs, spine,

ligamentous attachment to diaphragm and the posterior abdominal wall ,shear forces during deceleration injury.

Mechanisms of injury:-

High-velocity bullet injuries– burst injuries with distant contusions and

parenchymal disruption.

– Associations

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.

Mechanisms of injury:-

Isolated liver injury occurs in less than 50% of patients.

Blunt trauma 45% with spleen Rib fracture 33% with Liver injury

Associations:

Injuries

Parenchymal damage Subcapsular hematoma Laceration Contusion Hepatic vascular disruption Bile duct injury

Injuries

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

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

Elevated LFTs DPL -- high sensitivity CT scan is the diagnostic procedure of

choice. US. MRI ??

Angiography

active bleeding Transcatheter embolization Embolization & stenting for fistulas.

CT Scan

Localization. monitor healing. Grades 1-6

Classification(AAST)

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

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

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

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

V- Global destruction or devascularization of the liver.

VI-Hepatic avulsion

Gallbladder injuries…

Rare Predisposing factors. contusions, avulsions, lacerations or

perforations.

In the past VS now treatment of blunt liver injury trauma 86% , 67%

CT scan diagnosis and follow up

Management

Management…

Remember associated injuries Resuscitate Assessment of injury

Spiral CT

Laparotomy

♦ Treatment

Management…

consider Cryoprecipitate, FFP Rooftop incision Control blood Loss

Suturing of Lacerations Resection Packing Recurrent parenchymal bleeding

transcatheter embolization

Thank you