View Full Version : INJURIES OF THE LIVER (Etiology-Pathology-Clinical picture-Complications-Investigations-Treatment)

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06-06-2008, 09:28 PM
Liver injuries are not common because the position of the liver under diaphragm protected by the chest wall.
m Aetiology:
1. Open injury by stabs, bullets.
2. Blunt injury e.g. run-over accidents. Associated fractures of ribs, haemothorax and other abdominal and thoracic organs injuries may be found.
m Types of Injuries:
1- A subcapsular haematoma. 2- A longitudinal or stellate tear.
3- Extensive laceration.
4- Central rupture of the liver parenchyma.
5- Rupture of the vessels and ducts in the hilum and avulsion of the liver is usually fatal, but fortunately rare. Liver injuries are common on the anterior and superior surfaces.
mClinical Picture
There may be general manifestations of internal hemorrhage associated with pain, tenderness, and rigidity over the liver. Percussion may reveal the presence of blood in the peritoneum and paracentesis may confirm the diagnosis.
m Investigations:
Rapid evaluation and resuscitation is started one the patient is received. Patients who are hemodynamically stable but have objective clinical signs should be investigated as follow:
1- X-ray may show elevation of the diaphragm by a haematoma.
2- Coeliac angiography may show the site of injury.
3- I.V contrast enhanced CT scan of the chest and abdomen. This can define liver injury and other associated injuries.
m Treatment:
Laparotomy or thoracotomy is usually needed in cases of penetrating injuries. This is usually done during resuscitation when adequate blood is available. The Tear or tears should be sutured using matress sutures. Necrotic tissues should be removed to avoid infection and secondary haemorrhage. Packs are better avoided because they increase the chances of infection and it is better to ligate or suture the vessels rather than to pack the wound. A thoracic extension of the laparotomy may be needed to control bleeding from deep lacerations.
The most serious complications are infection with secondary haemorrhage and haemobilia. In haemobilia a communication occurs between one of the blood vessels and a bile duct. This may lead to severe gastro-intestinal bleeding. Percutaneous embolisation of the affected vessel can cure the condition. If failed surgical exploration to ligate the vessel is needed.
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