Liver injury , also known as liver laceration , is some form of sustained trauma to the liver. This can happen either through a blunt style like a car accident, or a foreign object that pierces like a knife. Liver injury accounts for 5% of all trauma, making it the most common stomach injury. Generally nonoperative management and observation is all that is required for full recovery.
Video Liver injury
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Given the anterior position in the abdominal cavity and its large size, it is susceptible to gunshot wounds and stab wounds. The company's location under the diaphragm also makes it very susceptible to shear forces. Common causes of this type of injury are blunt force mechanisms such as motor vehicle accidents, falls, and sports injuries. Usually this blunt force disappears through and around the liver structure. Most of the people who suffered this injury also suffered another injury.
Maps Liver injury
Diagnosis
Imaging, such as the use of ultrasound or computed tomography scans, is a generally preferred way of diagnosis because it is more accurate and sensitive to bleeding; because logistics is not always possible. For someone who is hemodynamically unstable, a focused assessment of sonography for trauma (FAST) scans may occur that are used to find free floating liquids in the upper right quadrant and lower left abdominal quadrants. However, FAST scanning may not be indicated in those who are obese and those with subcutaneous emphysema. His speed and sensitivity to injury resulted in 400mL of free-floating fluid making it a valuable tool in the evaluation of unstable people. Computed tomography is another diagnostic study that can be done, but it is usually only used in those with stable hemodynamics. Physical examination may be used but is usually inaccurate in blunt trauma, unlike in penetrating trauma where the path of the projectile taken can be digitally followed. A peritoneal lavage diagnostic (DPL) may also be used but has limited applications as it is difficult to determine the origin of the bleeding. A peritoneal lavage diagnostic is generally discouraged when it is available because it is invasive and non-specific.
Classification
Liver injuries were classified according to the most severe scale of Roman numerals with me, to the most severe VI. Generally any injury> = III requires surgery.
Management
Initial management of liver trauma generally follows the same procedure for all trauma with a focus on maintaining airway, breathing, and circulation. Physical examination is the cornerstone of judgment with various non-invasive diagnostic tools that can be utilized. An invasive lavage peritoneal diagnostic can also be used to diagnose and classify the extent of damage. Most of the liver injuries are small and require only observation. Generally if it is estimated there are less than 300mL of free floating fluid, no injury to the surrounding organs, and no need for blood transfusion, there is a low risk of complications from nonoperative management. In special cases where there is a higher risk of surgery, such as in the elderly, nonoperative management will include infusions of red blood cells packed in an intensive care unit. Usually a liver injury caused by a stab wound causes minor damage unless the vital part of the liver is injured, such as the hepatic portal vein; with gunshot wounds, the damage is worse.
Surgery
In severe liver injury (class> = III), or those with hemodynamic instability, surgical correction is generally required. In this severe injury, a hepatopancreatobiliary surgeon may be used rather than a trauma surgeon who is given his expertise with organs and generally produces better results. Surgical techniques such as perihepatic packing or the use of Pringle maneuvers can be used to control bleeding. Temporary control of bleeding can be done through direct manual pressure to the wound site. In these severe cases it is important to prevent the development of trauma death trials, which often require the use of damage control operations. A common cause of death during surgery is exsanguination caused by excessive blood volume loss. Rarely, surgery requires the use of liver resection, which removes sources of bleeding and necrotic tissue. The drastic nature of this procedure means it can only be used in patients with stable hemodynamics. Another rare procedure is a liver transplant that is usually not practical because logistics finds the right organ donor in a timely manner.
Kousnetzoff aluminum needles are used to sew liver tears. Co-opting seams are placed perpendicular to the seams of parallel mattresses that have been placed on either side of the laceration. Other methods are tractomy and hepatorrhaphy mesh.
History
In the 1880s a severe liver injury in many cases would be fatal within the first 24 hours after injury. Prior to the 1980s, nonoperative management was rarely used to support the management methods advocated by James Hogarth Pringle. During World War II the early use of laparotomy was popularized and along with the use of transfusions, advanced anesthetics, and other new surgical techniques led to decreased mortality.
References
Bibliography
- Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest J (2012). Trauma, Seventh Edition (Trauma (Moore)) . McGraw-Hill Professional. ISBN: 0-07-166351-7.
- Andrew B., MD Peitzman; Andrew B. Peitzman; Michael, MD Sabom; Donald M., MD Annual; Timothy C., MD Fabian (2002). Manual trauma . Hagerstwon, MD: Lippincott Williams & amp; Wilkins. ISBNÃ, 0-7817-2641-7.
Source of the article : Wikipedia
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