Liver Injury Overview and Aetiology

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a common treatment method for necrotic tissue in the liver?

High-dose corticosteroids

Systemic antibiotics and aspiration under ultrasound guidance (correct)

Topical antiseptic application

Surgical resection only

Which procedure is recommended for managing biliary fistulas if initial treatments fail?

General observation without intervention

Percutaneous transhepatic drainage or stent insertion (correct)

Chemotherapy followed by surgical intervention

Transplantation of the affected liver segment

What is the typical response of the liver after extensive trauma, according to recovery expectations?

Permanent damage without any regenerative ability

Likely to lead to multiple organ failure

Sluggish recovery with extensive scarring

Remarkable recovery with rapid parenchymal regeneration (correct)

What is the initial treatment for a dominant extrahepatic bile duct stricture associated with obstructive jaundice?

Endobiliary balloon dilatation or stenting Signup and view all the answers

How can vascular complications in the liver be treated nonsurgically?

Transarterial embolisation by a specialist interventional radiologist Signup and view all the answers

What is the primary purpose of diagnostic peritoneal lavage (DPL) in cases of suspected abdominal injury?

To identify the presence of free intraperitoneal fluid Signup and view all the answers

In a patient with a penetrating abdominal wound and haemodynamic instability, what is the recommended immediate action?

Transfer directly to the operating theatre Signup and view all the answers

Which test is particularly useful for diagnosing free intraperitoneal fluid in trauma cases?

FAST Signup and view all the answers

What is a critical step in the initial management of patients with severe abdominal injuries?

Maintenance of airway patency, breathing, and circulation Signup and view all the answers

Which of the following interventions should be prioritized for patients with suspected haemothorax?

Insertion of intercostal chest drains Signup and view all the answers

What is a potential consequence of neglecting to transfer a patient with massive blood loss to the operating theatre promptly?

Increased risk of coagulopathy Signup and view all the answers

What type of scan is recommended for haemodynamically stable patients after initial management?

Contrast enhanced CT scan Signup and view all the answers

What is the primary focus when addressing liver injuries during surgery?

Arresting the bleeding Signup and view all the answers

What method can be used to temporarily control brisk liver hemorrhage during surgery?

Temporary packing and Pringle's manoeuvre Signup and view all the answers

Why should suturing liver tears be avoided whenever possible?

It may lead to infection or bile duct communication Signup and view all the answers

What complication can arise from a liver haematoma that communicates with a torn bile duct?

Haematobilia Signup and view all the answers

In which scenario is suturing of liver tears most likely to be deemed necessary?

When control of bleeding vessels is impossible in deep tears Signup and view all the answers

What is the best approach to manage a shattered liver lobe that cannot be salvaged?

Excision of the lobe Signup and view all the answers

What should be the immediate action upon the arrival of a patient requiring fresh frozen plasma and cryoprecipitate?

Discuss with the blood transfusion service about the necessity of these components. Signup and view all the answers

What does thromboelastography (TEG) assist with in patients with acute loss of clotting factors?

It helps in making empiric decisions regarding factor administration. Signup and view all the answers

What precaution is routinely taken after managing liver trauma?

Placement of multiple intraperitoneal drains Signup and view all the answers

What is a possible consequence of inadequate management of liver injuries?

Death from blood loss Signup and view all the answers

In which situation should a laparotomy be performed immediately?

For patients who are haemodynamically unstable. Signup and view all the answers

What imaging should be considered for haemodynamically stable patients prior to laparotomy?

A contrast CT scan to evaluate the nature of the injury. Signup and view all the answers

Which of the following indicates a complication from penetrating liver trauma?

Abscess formation Signup and view all the answers

What is the role of prophylactic antibiotics in liver trauma management?

To avoid post-operative infections Signup and view all the answers

What indicates the need to discontinue conservative treatment for blunt liver injury?

Emergence of generalised peritonitis. Signup and view all the answers

What are the consequences of ignoring reimaging for patients with vascular injury indications?

Potentially treatable false aneurysms may develop. Signup and view all the answers

What is the role of interventional radiology in managing liver trauma?

To assist in the control of hepatic artery bleeding through embolization. Signup and view all the answers

What is a typical characteristic of patients suitable for conservative management of blunt liver injuries?

They must be haemodynamically stable without peritonitis. Signup and view all the answers

How should a subcapsular or intrahepatic hematoma be managed?

It requires conservative management to resolve spontaneously. Signup and view all the answers

What is the primary purpose of the Pringle maneuver during liver surgery?

To control bleeding from the liver Signup and view all the answers

What is a critical step to take if there is direct damage to the portal vein during surgery?

Repair the damage to the vein Signup and view all the answers

What vascular complication is associated with unavoidable ligation of the hepatic artery?

Necrosis of liver tissue Signup and view all the answers

During laparotomy, a specific incision is recommended to provide excellent access to which organs?

Liver and spleen Signup and view all the answers

After hepatic surgery, what should be done to manage potential fluid collection?

Leave a closed suction drainage system in situ Signup and view all the answers

What is the recommended suture material for repairing portal vein injuries?

5/0 Prolene Signup and view all the answers

What complication can arise from major hepatic vein injuries during surgery?

Warm ischaemia of the liver Signup and view all the answers

Which procedure is used as a workaround when the direct repair of the portal vein is not technically feasible?

Venovenous bypass Signup and view all the answers

What is the best approach to handle a stab incision on the liver?

Suture it with fine absorbable monofilament Signup and view all the answers

What should be avoided during hepatic injury repair to ensure better outcomes?

Using omentum to pack Signup and view all the answers

Study Notes

Liver Injury

The liver is the second most common organ injured in abdominal trauma, after the spleen.
Liver injuries are often associated with damage to other abdominal organs (e.g., ribs, pleura, lungs, colon, spleen).
Liver injury prognosis depends on the associated injuries; mortality averages 15-20%.

Liver Injury Aetiology

Blunt trauma: Direct impact; commonly causes contusion, laceration, and avulsion of the liver. Often associated with other injuries (spleen, kidney). More frequent and has higher mortality than penetrating injuries.
Penetrating trauma: Stab or gunshot wounds; often associated with chest or pericardial involvement; may or may not require surgery.
Iatrogenic injury: Increasingly common due to percutaneous procedures (e.g., liver biopsy, cholangiography).
Spontaneous rupture: Extremely rare, can be associated with conditions like eclampsia or certain liver tumours.

Liver Injury Pathology

Severity of injury: Classified into increasingly serious types
- Small subcapsular hematoma
- Small superficial tear(s)
- Large subcapsular or intrahepatic hematoma
- Large deep tear(s)
- Shattered liver parenchyma (including a whole lobe)
- Vascular injury (main hepatic veins are most difficult to manage)

Initial Management of Liver Injuries (Penetrating)

ABCs: Airway, breathing, and circulation are paramount.
Access: Two large-bore IVs, blood samples for tests (cross-matching, CBC, urea, electrolytes, liver function tests, clotting times, glucose, amylase)
Volume replacement: Blood products (initial volume replacement).
Diagnosis: Arterial blood gases, intubation and ventilation when necessary, chest drains if pneumothorax/hemothorax suspected.
Transfer: If stable, CT scan of the abdomen and chest; Immediate transfer to the operating room.
- Resuscitation continue on the operating table.
- Fresh frozen plasma and cryoprecipitate availability should be confirmed.

Blunt Liver Trauma Management

Unstable patients: Immediate laparotomy is required.
Stable patients: CT scan to evaluate the extent of the injury and associated vascular/biliary structures.
Conservative management: Possible for those who are stable. Ongoing monitoring with repeat CT scans is essential. Ongoing blood loss, evidence of coagulopathy, or developing peritonitis indicate a need for surgery.

Surgical Management of Liver Trauma

Access: Wide incision, (extended to the chest if needed).
Exploration: Comprehensive and careful abdominal exploration.
Bleeding control: Local control (suturing bleeding vessels, using packing materials); rarely shunting techniques, angioembolization.
Repair or resection/ligation: Repair tears, control major injuries. Excision of severely damaged lobes if needed.
Intra/peri-operative procedures: Pringle’s maneuver and hepatic artery control, ligation.
Post-operative measures: Multiple intraperitoneal drains to prevent fluid collections, prophylactic antibiotics.

Biliary Injuries

Classification: Leaks, transections, occlusion (ligation/stricture), or a combination. Iatrogenic injury following cholecystectomy is more common than traumatic injury.
Symptoms: Abdominal pain, nausea, anorexia, abdominal distention, (less commonly ascites and bile peritonitis).
Diagnosis: Ultrasound (fluid collections), radionuclide biliary scintigraphy (ongoing leakage), CT scan, (HIDA scan - highly accurate for diagnosis).
Treatment: Roux-en-Y choledochojejunostomy for repair of transected bile ducts. Conservative management or surgery depending on severity, extent and stability.

Complication/Other notes

Abscess formation
Bile leakage
Vascular complications (hepatic artery aneurysm, arteriovenous fistulae and arteriobiliary fistulae).
Liver failure
Hepatic injury long-term complications - strictures, abscesses
Treatment approach for stable and unstable patients.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the critical aspects of liver injuries, including their causes, associated injuries, and prognosis. Understand both blunt and penetrating trauma's impact on the liver, alongside considerations of iatrogenic and spontaneous injuries. Test your knowledge on this significant topic in abdominal trauma.