LIVER DISEASES

M. Anil Kumar
9th term

Liver trauma

Relatively uncommon

Second most common organ injured in

abdominal injury

Often associated with injuries to spleen

and also to the pericardium

classification

diagnosis

History:
a. History of trauma to the
1.lower anterior chest wall
2.upper abdomen
b. crushing injury to upper abdomen
c .injuries to the ribs

investigations

FAST- focused assessment sonography in

trauma

Contrast enhanced CT scan

Diagnostic peritoneal lavage

Initial management

1.
2.
3.
4.
5.

Penetrating injury:
Assessment
Airway
Breathing
Circulation
Relevant investigations: full blood count
electrolytes
LFT
blood
urea&s.creatinine

Blood grouping and cross matching

should be done

I.v colloids for fluid management

Blood transfusion

Assessment of clotting factors-TEG

Intercostal drainage tube insertion

BLUNT INJURIES:
o Initial resuscitation-same as penetrating
ijuries
o Assessment for hemodynamic stability
o If stable-CT scan performed
o Then conservative management
Indications to stop the conservative
management are: evidence of intra
abdominal haemorrhage

Surgical management

Initial step-gain of good access to the

organ

Rooftop incision with midline

extension till xiphisternum and retraction
of costal margin

Lateral transverse extension towards

right gives good access to the liver

Still bleeding persists-look for hepatic

artery lacerations and repair with6/0
proline
Portal vein injuries-repair with5/0 proline