liver trauma management in emergency
TRANSCRIPT
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Liver trauma management in emergency
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TRAUMA :study of medical problems associated with physical injuries.
ABDOMINAL TRAUMA:
1. haemodynamically stable.
2. haemodynamically unstable.
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TYPES OF TRAUMA
BLUNT TRAUMA ;e.g decelerating injuries, RTA and assaults.
PENETRATING TRAUMA: e.g stab wounds , GSW.
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PROBABLE INJURIES DUE TO ABDOMINAL TRAUMA: SOLID ORGAN INJURIES: include liver ,spleen
and kidney.
HOLLOW ORGAN INJURIES: stomach, intestines and bladder.
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INITIAL EVALUATION AND TREATMENT.
Is there any injury to liver??
1. HISTORY: penetrating
wound at rt. Hypochondrium, sever crush injuries, injuries to lower chest and upper abd ,deceleration injuries.
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2.Clinical feature2.Clinical feature1. peritoneal signs: Acute
abdominal pain , guarding, tenderness, rebound tenderness, rigidity , nausea.
2. DRE.
3. Haemodynamic instability
4. Lower rib fxs: 10-20% a/w spleen/liver injury a/w intestinal injury and mesenteric tears.
5. Contusion, often late sign.
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INVESTIGATIONS.
CT scan ;Gold standard.
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DPL.1 .crystal clear.
2 .Blood or gut contents
3. Slightly blood stained
4.>10 ml of blood.
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FAST.
DIAGNOSTIC LAPROSCOPY.
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Hepatic angiography.
CBC , LFT , RFT , CLOTTING SCREEN,GLUCOSE, AMYLASE ,ABG,s
CXR, Pelvic X-ray
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Treatment
Suspected minor liver trauma or blunt trauma;
resuscitation and close observation.
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1. Airway 2. breathing 3. Circulation4. Two wide bore cannulas5. Initial volume replacement
with colloids or O-ve blood gp.
6. Send baselines.7. Arrange at least 10 units of
blood.8. FFP and Cryoprecipitates.
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SUSPECTED MAJOR TRAUMA OR PENETRATING INJURY: Resuscitation and laparotomy is essential.
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Approach :
roof top incision.
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AT LAPAROTOMY??!!!!
4 important “ P s” 1.Push 2.Pringle 3.Plug 4.Pack
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Suturing of lacerations. Lobectomy of Avulsed lobe. Necrotic tissue removal. Vascular repair .,,,,if not
possible on table; veno-venous shunt.
Anti biotic cover. DON’T FORGET
ASSOCIATED INJURIES.
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