Liver injury


Liver Injury

Description, Causes and Risk Factors:

Liver is the largest internal organ and the largest gland of the human body. There are many liver functions that make it a crucial part of the human anatomy. It is the liver that helps in the processing of food from the intestines and it also secretes bile (a fluid that does the work of digestion as well as helps in the transportation of fats and wastes into the intestine). Liver plays a key role in neutralizing the dangerous affects of drugs and toxins. Besides these, liver helps in manufacturing and regulating various hormones including sex hormones. It also makes enzymes that facilitates chemical reactions in the body and stores vitamins like iron and other necessary chemicals. Still, being such a crucial organ, liver is prone to serious diseases and injuries.

Liver injury may be of:

    Liver contusion: Bruising of the liver.

  • Liver laceration: Cut to the liver.

  • Liver rupture: Bursting injury of the liver.

Liver injury is caused by traumatic injury, it will generally be divided into open and closed injury. Openness in general there is a gunshot wound, knife stab injury, etc. Liver-fire device injured abdominal gunshot wounds are the most common injury, another opening up can be divided into the blind gut wound and penetrating wound. Blunt abdominal trauma found to blunt injury, mainly due to impact, squeeze caused by common in road traffic accidents, buildings collapse, occasionally falling in height, sports injury or assault injury. Because of blunt abdominal trauma in addition to liver trauma often combined other organ injury and abdominal injuries surface without signs, diagnosis is relatively difficult to have some cause treatment delays, therefore the more dangerous blunt injuries, the fatality rate is often higher than the open injury.

Stab wounds and cuts caused by hepatic parenchymal injury are relatively light. Bullet and shrapnel often caused by penetrating injuries or blind wound, the degree of injury and injury location and speed are closely related to the warhead. Usually by representatives of the following formula:

Risk Factors:

    Altercations.

  • Falls.

  • Sport injury.

  • Gunshot wound.

  • Stab wound.

Types:

Subcapsular liver laceration: Most have a subcapsular hematoma. If not serious injured, have atypical clinical manifestations, only the liver or right upper quadrant pain, right upper quadrant tenderness, liver pain, sometimes palpable tender liver. No obvious hemorrhagic shock and peritoneal irritation.

The central liver laceration: Hematoma formation in deep, not the typical symptoms. Such as intrahepatic bile duct injury at the same time, blood flow of bile duct and duodenum, showed paroxysmal Biliary Colic and upper gastrointestinal bleeding.

Severe liver injury may include:

    Any liver injury associate with cardiovascular compromise.

  • Liver injury in a patient with significant liver comorbidity.

  • Any liver injury grade III-VI.

Grades:

Grade I

    Grade I: Laceration: Capsular tear, <1 cm parenchymal depth.

  • Grade II: Laceration 1-3 cm parenchymal depth which does not involve a trabecular vessel.

  • Grade III: Laceration >3 cm parenchymal depth or involving trabecular vessels.

  • Grade IV: Laceration involving segmental or hilar vessels producing major devascularization.

  • Grade V: Hilar vascular injury which devascularizes spleen.

Symptoms:

Symptoms may be:

    Right upper abdominal pain.

  • Abdominal swelling.

  • Abdominal tenderness.

  • Blood in the stool and urine.

  • Liver related diseases such as jaundice.

  • Vomiting.

  • Rapid pulse.

  • Fainting.

Diagnosis:

The diagnosis of liver laceration may be difficult and must be integrated with the injury for a comprehensive analysis of clinical manifestations.

Initial steps:

    Watch for potential complications:

  • Bile leak.

  • Infected hematoma.

  • Haemobilia.

Tests:

    X-ray examination: If the liver subcapsular hematoma cavity organ injury.

  • B-ultrasonic inspection: This method is not only able to detect intra-abdominal hemorrhage and subcapsular hematoma of the liver and intrahepatic hematoma also help the diagnosis, are more commonly used clinically.

  • Determination of red blood cells, hemoglobin and hematocrit: To observe the dynamic changes in anemia if there is to carry out the performance, express for internal bleeding.

  • Radionuclide liver scan: the diagnosis for unclear blunt Hepatic injury, suspected liver subcapsular or intrahepatic hematoma, the injury is not an emergency, the sick can be used when circumstances permit isotope liver scan. Intrahepatic hematoma from radiation defect performance

Treatment:

Operative therapy has been the standard of care for liver injuries from the beginning of the century until the beginning of the 1990s. However, surgical literature confirms that as many as 86% of liver injuries have stopped bleeding by the time surgical exploration is performed, and 67% of operations performed for blunt abdominal trauma are non-therapeutic. Imaging techniques, particularly CT scanning, have made a great impact on the treatment of patients with liver trauma, and use of these techniques has resulted in marked reduction in the number of patients requiring surgery and non-therapeutic operations.

The principle of surgical treatment of liver injury is complete hemostasis, removal of the fragmentation in liver tissue and placement of peritoneal abteilung in order to prevent secondary infection. Hemostasis is the crux of Hepatic injury treatment, whether effective control of bleeding can directly affect the mortality rate of Hepatic injury. The lost vitality fragmentation of liver tissue is necrosis decomposition, accumulation of both blood and bile will eventually formed secondary infection and lead to intra-abdominal abscess.

Surgical options may be:

    Simple sutures.

  • Debridement.

  • Hepatic artery ligation.

  • Hepatectomy.

  • Tamponade hemostasis.

Other treatment options depending on the liver injury type include:

    Treatment for injury of hepatic inferior vena cava or hepatic vein stem.

  • Treatment for subcapsular hematoma of the liver injury.

  • Treatment for Central Hepatic injury.

  • Treatment of penetrating injury of liver.

Intervention is required in patients with active bleeding in the liver, particularly if this bleeding occurs into a low pressure space as the peritoneal cavity or pleural space. If the patient is unstable hemodynamically and cannot be adequately resuscitated emergency surgery is required, perhaps using “damage control” techniques followed by angiographic intervention. Pseudoaneurysms that occur within liver injuries that extend to the capsule have a higher propensity for rupture and bleeding under or through the capsule and should be embolized. Pseudoaneurysms that are surrounded by intact liver parenchyma may resolve without embolization and can be followed initially. If the aneurysm shows expansion or injury extension to the capsule then angiography with embolization is needed. Patients with traumatic hepatobiliary or hepatovenous fistulas also should undergo angiographic closure.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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