The LiverLiver TraumaLiver Abscess
Francisco Javier Robles Saucedo
Clinical Surgery DepartmentDr. Benjamin Robles MadrigalDr. Hector Manuel Vírgen Ayala
The Liver
Functions
1) Blood2) Metabolism3) Bile4) Iron & Vitamins
Deposit5) Coagulation
Factors
Liver Trauma
Piercing (>50%)Proyectile, Knife.
BluntDirect Hits
Explosive woundsOutbreakLineal lacerations
Sudden Deceleration
Symptoms
Hipovolemic shock
Blood PressureDiuresisVein Pressure
Abdominal distension
Dx. CTECOBH
Tx.StapleDebridement
Grade Tipe Description
I HematomaLaceration
No expansion, Subcapsular, superficial area < 10%Capsular tear, No hemorrhage, depth< 1cm
II HematomaLaceration
Subcapsular, No expansion, superficial area < 10 – 50%, in parenquima.Capsular Tear, Active Hemorrhage, depth1 – 3cm, lenght < 10cm
III HematomaLaceration
Subcapsular, Superficial area > 50%, subcapsular tear, active hemorrhage.Depth in parenquima > 3cm
IV HematomaLaceration
Hematoma tear in parenquima, active hemorrhage.Parenquima rupture > 50% hepatic lobe
V HematomaVascular
Parenquima rupture >50% hepatic lobeJuxtaposed veins (cava or major hepatic) damage
VI Vascular Hepatic Avulsion
Abscess
Pyogenic(E. coli)
Amebic(E. Histolytica)
Exposure Routes1) Biliar Tree2) Portal vein3) Hepatic artery4) Direct extension of a nearby focus of infection5) Trauma
Clinical Features Amebic Abscess Pyogenic Abscess
Age 20 - 40 50
Male – to – Female ratio >10:1 1.5:1
Solitary vs. Multiple Solitary 80% Solitary 50%
Location Ussually right liver Ussually right liver
Travel in endemic area yes No
Diabetes Uncommon (2%) More common (27%)
Alcohol Use Common Common
Jaundice Uncommon Common
Elevated Bilirrubin Uncommon Common
Elevated alkaline phosphatase
Common Common
Positive Blood Culture No Common
Positive Amebic serology Yes No
Amebic Pyogenic
FeverJaundiceChillCought & DysneaAbdominal pain & Tenderness
Leu > 15,000Anemia (Hto 33%)
Dx.
RxCTECO
Tx
DrainAntibiotics or AzolesLaparotomy
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