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Dr. Aisha Al-Zuhair General Surgery KFHU – Khobar – Saudi Arabia Dec 16, 2009
 
Surface anatomy ,[object Object],[object Object],[object Object],[object Object]
Surface anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
[object Object],[object Object]
Ligaments  ,[object Object],[object Object],[object Object],[object Object]
Fissures
Segmental anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Segmental anatomy ,[object Object],[object Object]
 
 
Blood Supply ,[object Object],[object Object],[object Object]
 
Blood Supply – Portal Vein ,[object Object],[object Object],[object Object],[object Object],[object Object]
Blood supply – Hepatic artery ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
Blood supply – Hepatic vein ,[object Object],[object Object],[object Object],[object Object]
 
Radiological anatomy
Radiological anatomy
 
Introduction  ,[object Object],[object Object],[object Object],Richardson JD. Ann Surg. 2000;232:324-330.  Lucas CE. Am Surg. 2000;66:337-341.
[object Object],[object Object],JH Pringle, 1908
History of Liver Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Factors making the liver prone to injury: ,[object Object],[object Object],[object Object],[object Object]
 
1. Moore EE, Cogbill TH, Jurkovitch GJ, Shackford SR, Malangoni MA, Champion. Organ injury scaling-spleen, liver (1994 rev). J Trauma. 1995; 38:323-4
Grade 1 ,[object Object],Contrast CT demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1 cm thick.
Grade 2 ,[object Object],CT scan at the level of the hepatic veins shows a subcapsular hematoma 3 cm thick.
Grade 3 ,[object Object],Contrast CT shows a 4-cm-thick subcapsular hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of the right lobe of the liver..
Grade 4 ,[object Object],CT scan of the abdomen demonstrates a large subcapsular hematoma measuring more than 10 cm. The high-attenuating areas within the lesion represent clotted blood
Grade 4 ,[object Object],Contrast CT shows a large parenchymal hematoma in segments 6 and 7 of the liver with evidence of an active bleed. Note the capsular laceration and large hemoperitoneum.
Grade 5 ,[object Object],CT demonstrates global injury to the liver. Bleeding from the liver was controlled by using Gelfoam.
 
 
 
Management   ,[object Object],[object Object],[object Object]
 
Non-Operative Management of Liver Injury ,[object Object],[object Object],Knudson MM. Surg Clin North Am. 1999;79:1357-1371.  Malhotra AK. Ann Surg. 2000;231:804-813.  Maull KI. World J Surg. 2001;25:1403-1404.  Pachter HL. Am J Surg. 1995;169:442-454.    Sherman HF J Trauma. 1994;37:616-621.  Schweizer W. Br J Surg. 1993;80:86-88.  .  Miller PR. J Trauma. 2002;53:238-242.    Goan YG. J Trauma. 1998;45:360-364.  Brasel KJ. Am J Surg. 1997;174:674-677.  .  Ochsner MG.. World J Surg. 2001;25:1393-1396.
Criteria for NOMLI ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
High Success With Non-operative Management of Blunt Hepatic Trauma ,[object Object],[object Object],[object Object]
Cont. ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cont. ,[object Object],[object Object],[object Object],[object Object]
Complications of NOMLI ,[object Object],[object Object],[object Object],[object Object],[object Object]
Failure of NOMLI  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Criteria of failure of NOMLI ,[object Object],[object Object],[object Object],[object Object],[object Object]
How to manage conservatively Grade I II III IV ICU 0 0 0 1 Hospital stay (d) 2 3 4 5 Activity Restriction (w) 3 4 5 6
Follow up  ,[object Object],[object Object],2003 Eastern Association For The Surgery of Trauma
 
Indications  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Operative technique/options ,[object Object],[object Object],[object Object],[object Object],[object Object]
Operative technique/options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],commonest Juxtahepatic venous injury
 
 
 
 
Operative technique/options ,[object Object]
1. Moore EE, Cogbill TH, Jurkovitch GJ, Shackford SR, Malangoni MA, Champion. Organ injury scaling-spleen, liver (1994 rev). J Trauma. 1995; 38:323-4
 
 
 
 
 
 
Hepatic segments Resections ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
References  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Liver Trauma

Notas do Editor

  1. The superior, anterior, and right lateral surfaces of the liver are smooth and convex, fitting against the diaphragm. The posterior surface has indentations from the colon, right kidney, and duodenum on the right lobe and the stomach on the left lobe
  2. Common resections acc to the segmants: Right hemihepatectomy (segments 5 to 8, or right hepatectomy, right hepatic lobectomy) Right trisectionectomy (segments 4 to 8, or right lobectomy, trisegmentectomy of Starzl) Left hemihepatectomy (segments 1 to 4, or left hepatectomy, left hepatic lobectomy) Left lateral sectionectomy (segments 1 to 3, or left lobectomy, left lateral segmentectomy).
  3. Common resections acc to the segmants: Right hemihepatectomy (segments 5 to 8, or right hepatectomy, right hepatic lobectomy) Right trisectionectomy (segments 4 to 8, or right lobectomy, trisegmentectomy of Starzl) Left hemihepatectomy (segments 1 to 4, or left hepatectomy, left hepatic lobectomy) Left lateral sectionectomy (segments 1 to 3, or left lobectomy, left lateral segmentectomy).
  4. The 8 liver segments (namely 1, 2, 3, 4a, 4b, 5, 6, 7, 8) are numbered clockwise on the frontal view.
  5. The 8 liver segments (namely 1, 2, 3, 4a, 4b, 5, 6, 7, 8) are numbered clockwise on the frontal view.