Liver trauma management in emergency

TRAUMA :study of medical problems associated with physical injuries.

ABDOMINAL TRAUMA:

1. haemodynamically stable.

2. haemodynamically unstable.

TYPES OF TRAUMA

BLUNT TRAUMA ;e.g decelerating injuries, RTA and assaults.

PENETRATING TRAUMA: e.g stab wounds , GSW.

PROBABLE INJURIES DUE TO ABDOMINAL TRAUMA: SOLID ORGAN INJURIES: include liver ,spleen

and kidney.

HOLLOW ORGAN INJURIES: stomach, intestines and bladder.

INITIAL EVALUATION AND TREATMENT.

Is there any injury to liver??

1. HISTORY: penetrating

wound at rt. Hypochondrium, sever crush injuries, injuries to lower chest and upper abd ,deceleration injuries.

2.Clinical feature2.Clinical feature1. peritoneal signs: Acute

abdominal pain , guarding, tenderness, rebound tenderness, rigidity , nausea.

2. DRE.

3. Haemodynamic instability

4. Lower rib fxs: 10-20% a/w spleen/liver injury a/w intestinal injury and mesenteric tears.

5. Contusion, often late sign.

INVESTIGATIONS.

CT scan ;Gold standard.

DPL.1 .crystal clear.

2 .Blood or gut contents

3. Slightly blood stained

4.>10 ml of blood.

FAST.

DIAGNOSTIC LAPROSCOPY.

Hepatic angiography.

CBC , LFT , RFT , CLOTTING SCREEN,GLUCOSE, AMYLASE ,ABG,s

CXR, Pelvic X-ray

Treatment

Suspected minor liver trauma or blunt trauma;

resuscitation and close observation.

1. Airway 2. breathing 3. Circulation4. Two wide bore cannulas5. Initial volume replacement

with colloids or O-ve blood gp.

6. Send baselines.7. Arrange at least 10 units of

blood.8. FFP and Cryoprecipitates.

SUSPECTED MAJOR TRAUMA OR PENETRATING INJURY: Resuscitation and laparotomy is essential.

Approach :

roof top incision.

AT LAPAROTOMY??!!!!

4 important “ P s” 1.Push 2.Pringle 3.Plug 4.Pack

Suturing of lacerations. Lobectomy of Avulsed lobe. Necrotic tissue removal. Vascular repair .,,,,if not

possible on table; veno-venous shunt.

Anti biotic cover. DON’T FORGET

ASSOCIATED INJURIES.