Liver injury
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Susceptible to injury due to large size(1200-1600 g)
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Covered by bony thoracic cage
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Injury frequency - only 2nd after spleen( personal series)
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Highly vascular- only 4% of body weight but 28% of total body blood flow
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Double blood supply- portal vein & hepatic artery
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Draining hepatic veins- short and thin walled
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Spontaneous hemostasis- 50% of small lacerations
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Profuse bleeding is from deep hepatic lacerations
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Mortality: 8%- 10% Morbidity: 18%-30%.
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Diagnosis:
- Hemodynamically unstable- FAST
- Hemodynamically stable- FAST, CT scan
- Management based on hemodynamic status
(Image: Liver injury- CT scan)
Liver injury- Non-operative management
- Hemodynamically stable patients
- CT scan
- If No other indications for abdominal exploration
- ICU admission for close observation
- Serial hemoglobin estimation
- Transfusion requirements of <2 units of blood
- Surgery- if become unstable
Liver injury-Surgical management
Principles of surgical management:
- control of bleeding,
- removal of devitalized tissue, and
- adequate drainage.
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Bleeding vessels & biliary radicles are individually ligated.
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Pringle’s maneuver: clamping the hepatoduodenal ligament (the free border of the lesser omentum)
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Perihepatic packing- if fail to control bleeding.
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Packs removed in 48 hours.
