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