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Liver Injuries Liver - # 2 most commonly injured organ in blunt abdominal trauma Liver - # 2 most commonly injured organ in blunt abdominal trauma Right.

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Presentation on theme: "Liver Injuries Liver - # 2 most commonly injured organ in blunt abdominal trauma Liver - # 2 most commonly injured organ in blunt abdominal trauma Right."— Presentation transcript:

1 Liver Injuries Liver - # 2 most commonly injured organ in blunt abdominal trauma Liver - # 2 most commonly injured organ in blunt abdominal trauma Right Lobe >>> Left Lobe Right Lobe >>> Left Lobe Posterior segment > anterior segment Posterior segment > anterior segment Caudate injury is rare, usually in assoc w/ right or left lobe injury Caudate injury is rare, usually in assoc w/ right or left lobe injury Mortality blunt traumatic hepatic trauma – 8-25% (uncontrolled hemorrhage) Mortality blunt traumatic hepatic trauma – 8-25% (uncontrolled hemorrhage)

2 Liver Injury Forms Laceration Laceration Intrparenchymal hematoma Intrparenchymal hematoma Infarction Infarction Subcapsular hematoma Subcapsular hematoma

3 American Association of Trauma Surgery – Hepatic Injury Scale I – Capsular tear, < 1 cm parenchymal depth I – Capsular tear, < 1 cm parenchymal depth II – Parenchymal tear, 1-3 cm depth II – Parenchymal tear, 1-3 cm depth III – Parenchymal disruption, > 3cm depth but involving 3cm depth but involving < 25% of the hepatic lobe IV – Parenchymal disruption, 25-50% of hepatic lobe IV – Parenchymal disruption, 25-50% of hepatic lobe V – Parenchymal disruption - > 50% of hepatic lobe V – Parenchymal disruption - > 50% of hepatic lobe VI – Hepatic avulsion VI – Hepatic avulsion

4 22 yr female Driver of pick up truck rear- ended by another 40mph Driver of pick up truck rear- ended by another 40mph Hemodynamically stable – BP 140’s/70’s, HR 80’s Hemodynamically stable – BP 140’s/70’s, HR 80’s Abdomen – soft, nondistended, tender w/ voluntary guarding Abdomen – soft, nondistended, tender w/ voluntary guarding Also with open LE fx Also with open LE fx Hct 43  34 during hospital course Hct 43  34 during hospital course ALT 599, Alk phos 73, LA 1.7 ALT 599, Alk phos 73, LA 1.7 CT Abd/pelvis done CT Abd/pelvis done Grade IV Liver laceration Grade IV Liver laceration V-shaped – occupies entire 4a segment V-shaped – occupies entire 4a segment Intact hilum Intact hilum Subcapsular hematoma Subcapsular hematoma Free fluid in pelvis Free fluid in pelvis No active extravasation No active extravasation Management – SICU observation, no transfusions, HD stable, 5 days bed rest, on floor, plan to d/c to home Management – SICU observation, no transfusions, HD stable, 5 days bed rest, on floor, plan to d/c to home

5 CT Abd/pelvis – Grade IV Liver Laceration

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9 Management Options Non-operative management of blunt hepatic and splenic injuries = TOC in HD stable pts, irrespective of injury grade Non-operative management of blunt hepatic and splenic injuries = TOC in HD stable pts, irrespective of injury grade No evidence for routine imaging of HD stable, clinically improving pt No evidence for routine imaging of HD stable, clinically improving pt HD unstable = surgery vs. selective hepatic artery embolization (portal system supplies flow to de-arterialized tissue until collaterals develop) HD unstable = surgery vs. selective hepatic artery embolization (portal system supplies flow to de-arterialized tissue until collaterals develop)

10 References Practice Management Guidelines for the Nonoperative Management of Blunt Injury to the Liver and Spleen, 2003 Eastern Association for the Surgery of Trauma Practice Management Guidelines for the Nonoperative Management of Blunt Injury to the Liver and Spleen, 2003 Eastern Association for the Surgery of Trauma Nonoperative management of blunt hepatic trauma: The exception or the rule?, Journal Trauma Nonoperative management of blunt hepatic trauma: The exception or the rule?, Journal Trauma Jason Zolak CC IV


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