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 feature
1. 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. Circulation
4. Two wide bore cannulas
5. 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.