Liver Damage

Liver injury can be the result of blunt or penetrating trauma. Patients have abdominal pain, sometimes radiating to the shoulder and are pressure sensitive. The diagnosis is made by CT or ultrasonography. Treatment includes observation and sometimes surgical repair, rarely, a partial hepatectomy is required.

(See also abdominal injuries at a glance.)

Liver injury can be the result of blunt or penetrating trauma. Patients have abdominal pain, sometimes radiating to the shoulder and are pressure sensitive. The diagnosis is made by CT or ultrasonography. Treatment includes observation and sometimes surgical repair, rarely, a partial hepatectomy is required. (See also abdominal injuries at a glance.) Etiology A considerable force (z. B. automobile accident) can damage the liver, as well as penetrating injuries (z. B. knife stab, gunshot wound). Liver injuries range from small subcapsular hematoma and injuries capsule over deep parenchymal cuts to massive crushing injuries and vascular tear-out. Classification liver damage depending on the severity in 6 classes divided (degree of liver damage) the degree of liver damage degree of injury 1 subcapsular hematoma <10% of the area of ??injury <1 cm deep 2 subcapsular hematoma 10-50% of the area, intraparenchymales hematoma <10 cm injury 1 -3 cm deep and <10 cm 3 subcapsular hematoma> 50% of the area, intraparenchy males hematoma> 10 cm or an expanding hematoma or torn injury> 3 cm deep 4 Parenchymal interference with 25-75% of the hepatic lobe or 1-3 Couinaud segments within a single lobe 5 Parenchymal disorder with> 75% of liver lobes or> 3 Couinaud segments Juxtahepatische venous injury (d. H. retrohepatische vena cava or central major hepatic veins) 6 liver failure crack Pathophysiology The most important immediate consequence is bleeding, the extent of blood flow can be low or solid, depending on the type and degree of injury. Many small injuries, especially in children, listen to spontaneous bleeding. Major injuries bleed extensively, often causing a hemorrhagic shock. The mortality is significantly increased in high-grade liver damage. Complications The overall incidence of complications is <7%, but can increase with high grade injury to 15-20%. Parenchymal depth cuts may lead to a biliary fistula or the formation of Biloma. In a biliary bile leaks unhindered into the abdominal or thoracic cavity. A Biloma is an encapsulated collection of bile like an abscess. Bilomas are usually treated with percutaneous drainage. In biliary fistula biliary decompression by percutaneous transhepatic cholangiography (ERCP) is very successful. Abscesses develop in about 3-5% of the injuries, often due to dead tissue that was exposed to bile content. The diagnosis is suspected in patients in whom pain, temperature and white blood cell count in the days to rise after the injury; a confirmation is made by CT. Abscesses are usually treated with percutaneous drainage, but a laparotomy may be necessary if the percutaneous treatment is unsuccessful. Symptoms and complaints of severe abdominal bleeding manifestations such. As hemorrhagic shock, abdominal pain and distention of the abdomen, and tenderness are usually clinically apparent. Lighter bleeding or hematoma cause right upper quadrant abdominal pain and tenderness. Diagnostic imaging methods (CT and ultrasonography) The diagnosis is confirmed by CT in stable patients with ultrasound at the edge of the bed or by exploratory laparotomy for unstable patients. Treatment observation The treatment consists of the embolization (sometimes) or of surgical ligation. Hemodynamically stable patients who have no other indications of laparotomy (z. B. Hohlorganperforation) are checked for vital signs and hematocrit values ??and observed. In patients with significant bleeding current (d. E. With hypotension and shock, the need for continuous massive transfusion or with declining hematocrit) is necessary engagement. Patients whose vital signs are stable, but require ongoing transfusion may be candidates for angiography with selective embolization of blood vessels. Unstable patients should be subjected to a laparotomy. The success rates for conservative treatment are about 92% for injuries 1st and 2nd degree, 80% for injuries grade 3, 72% grade 4 injuries and 62% of injuries 5th degree. Conservative therapies result, there is no consensus in the literature regarding the length of stay in intensive care, the hospital stay, the resumption of diet, duration of bed rest or restriction of activity (1). In an operation minor cuts can (oxidised cellulose, fibrin, thrombin, and mixtures of powdered gelatin z. B.) are treated usually sewn or hemostatic agents. Surgical treatment of the deeper and more complex injuries can be complicated. Treatment Note Stassen NA, Bhullar I, Cheng JD. Nonoperative management of blunt hepatic injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73: S288-S293, 2012. Key points The immediate main consequence is bleeding, often stop spontaneously, v. a., if it is to injury from grade 1 or 2. but they can make embolization or surgical intervention required; Mortality and morbidity can be significant in high-quality violations. Complications are the formation of biliary fistulas, Bilomas and abscesses. The diagnosis is confirmed by CT in stable patients. Treat with laparotomy (if unstable), monitoring (if stable), or sometimes with selective angiographic embolization (z. B. if stable, but ongoing transfusions are needed) patients.

Health Life Media Team

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