LIVER TRAUMA includes clinical features.pptx

It includes clinical features , investigations, treatment

1. LIVER TRAUMA NIHAL NIRAVIL ROLL NO: 99

2. Liver is the most vulnerable abdominal organ for injury,it is due to its Size Anterior location Mobility Fragile nature Thin Glisson’s capsule It is the most common organ injured in penetrating abdominal trauma

3. It is the 2nd most common organ injured in blunt abdominal trauma 40 percentage blunt liver trauma associated with splenic injury 30 percentage associated with rib fractures Liver injury can be of two types PENETRATING BLUNT

4. CLINICAL FEATURES Features of shock due to severe bleeding ,such as pallor,hypotension,tachycardia,weak thready pulse,sweating Distended abdomen with dull flank Guarding Rigidity Haemoperitonium Biliary peritonitis Localised haematoma

5. INVESTIGATIONS USG abdomen,FAST (focused assessment with sonography for trauma) CT scan of chest and abdomen Diagnostic peritonial lavage:10ml blood on initial aspiration, >1 lakh cumm RBCs,>500 WBCs,presence of enteric substance suggestive of positive DPL Hb%, PCV,Blood grouping and cross matching

6. ABG analysis Coagulation profile Thromboelastography dynamic form of assessing coagulation status on table. X-RAY to look for rib fractures

7. TREATMENT Initial management is maintenance of airway,breathing,circulation Have both central and peripheral venous access IV fluids,massive blood transfusion,FFP (as the patient develop irreversible coagulopathy due to lack of fibrinogen and clotting factors) Bladder catheterization to measure urine output

8. CONSERVATIVE MANAGEMENT It is done in, Non progressive liver injuries in patients who is haemodynamically stable,low grade (1-3)liver injury,needs of <2 units of blood transfusion,without peritonial signs ,normal mental status Replacement of lost blood,prevention of sepsis,regular monitoring By CT abdomen or USG,haematocrit,LFT,PT Angiographic embolization increases success rate

9. ICU management for 2-5 days, repeat CT scan after 5 days,bed rest to be continued,patient can have normal activity after 3 months. If condition worsens ,should be taken up for laprotomy

10. SPECIFIC TREATMENT It include push(direct compression), plud (plugging deep track injuriesusing silicone tube),Pringle’s manoeuvre,pack (liver wound directly pavked with mop) Firstly,laparotomy id sone through a large bucket handle abdominal incision or thoraco abdominal incision and look for extent of liver injury and associated injury To control bleding from hepatic artery and portal vein ontable,both are temporarly occluded at foramen of Winslow by Pringle’s manoeuvre

11. Ligation of bleeding vessel individually on cut surface is called tractotomy.biliary ductules also ligated. Liver is wrapped with absorbable mesh(mesh hepatorrhaphy ),to achieve haemostasis . ICT placement to thorax and repair diaphragmatic injury Cholecystectomy and placement of T tube in CBD Kous netzoff suture is used to suture liver tear. Post opratively patient need ventillatorysupport,blood transfusion,electrolyte management,antibiotic like cephalsporins,cefoperazone,FFP,cryoprecipitate .

12. PORTA HEPATIC INJURY Life threatening condition associated with penetrating injuries. Rare Portal vein is sutured after veno -venous bypass.

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