liver damage
Introduction
Introduction to liver damage The liver is the largest substantial organ in the abdominal cavity and carries important physiological functions of the human body. Hepatocytes are poorly tolerant to hypoxia, so hepatic arteries and portal veins provide a rich blood supply, and large and small bile ducts and blood vessels accompany bile. It is located in the deep upper right abdomen and has the protection of the lower chest wall and diaphragm. However, due to the large size of the liver and the brittle texture, once it is vulnerable to violence, it may cause intra-abdominal hemorrhage or bile leakage, causing hemorrhagic shock and/or biliary peritonitis. Must be diagnosed and handled correctly. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: underarm abscess biliary peritonitis abdominal abscess shock
Cause
Cause of liver injury
The disease is caused by external violence.
After the liver suffers from blunt violence, different types of liver laceration can be caused according to the size of the violence. The light is a superficial laceration, and the amount of bleeding is small, some can stop on their own; the severe laceration is deep, and some are irregular stars. Or even severely fragmented, lose vitality or fall off in the abdominal cavity. This damage is mainly manifested as intra-abdominal hemorrhage and hemorrhagic shock. The blood has certain irritation to the peritoneum, and mild peritoneal irritation may occur, such as bile duct fracture, bile External leakage has more serious signs of biliary peritonitis. If the trunk of the hepatic vein is injured, the posterior segment of the inferior vena cava, the dry branch of the portal vein may have a large amount of bleeding, which may soon occur in shock, or even die rapidly, lose vitality or scatter in the abdominal cavity. Liver tissue will decompose necrosis, together with accumulated blood and bile can be secondary bacterial infection to form abdominal abscess, subcapsular laceration due to intact capsule, hepatic parenchymal rupture and hemorrhage under the capsule to form a hematoma, light injury and less bleeding, The hematoma formed is small, some can be absorbed by themselves; the severe wounds have more bleeding, and the liver capsule can be widely separated to form a large hematoma. The compression of the hematoma can still make it week. Hepatic cell necrosis, hematoma can also be secondary infection to form abscess, high tension hematoma can turn the capsule into a true laceration, central liver laceration is mainly deep rupture of the liver parenchyma, and the liver capsule and shallow layer The liver parenchyma is still intact. This laceration can form a large hematoma in the deep part of the liver, which increases the volume of the liver, increases the tension, and is under pressure and necrosis of the tissue around the hematoma. This hematoma can penetrate into the abdominal cavity to form internal hemorrhage and peritonitis, or penetrate into the bile duct. It is characterized by biliary bleeding, and it can also form a liver abscess secondary to infection.
Openness, the severity of penetrating injury depends on the location of the liver injury and the rate of penetration of the wound. When the bullet and shrapnel penetrate the liver tissue, energy can be transmitted to the tissue around the ballistics, causing damage and injury to the hepatic hilum. In the case of large blood vessels, liver parenchymal damage may not be serious, but due to continuous massive hemorrhage, there is still a high mortality rate. In addition to the type of injury and injury, combined multiple organ injury is an important factor affecting the mortality of liver injury. The more organs, the more serious the injury, the harder the treatment and the higher the mortality rate.
Prevention
Liver injury prevention
The disease has been caused by external violence, and there are no effective preventive measures. In daily work and life, we should try to avoid the impact of external violence.
Complication
Hepatic injury complications Complications underarm abscess biliary peritonitis abdominal abscess shock
The most common complication is infection, the remainder is biliary, secondary bleeding and acute liver and kidney failure.
(1) Infectious complications
There are liver abscesses, underarm abscesses and wound infections, completely remove the vital liver tissue and pollutants, properly stop bleeding, and placement of reliable and effective drainage is an effective measure to prevent infection. Once the abscess is formed, it should be drained in time.
(two) liver wound bile leakage
It can cause biliary peritonitis or localized abdominal abscess. It is also a serious complication. The method of preventing bile leakage is to carefully ligature or suture the broken bile duct and place the drainage tube during operation. After bile leakage occurs, the common bile duct Placement of "T" shaped tube drainage can reduce the pressure in the biliary tract to promote healing.
(three) secondary bleeding
Due to improper treatment of the wound surface, there is dead space or necrotic tissue and secondary infection, so that the blood vessel collapses or the ligature line falls off and rebleeds. When the amount of bleeding is large, it is necessary to stop bleeding again and improve drainage.
(four) acute liver and kidney dysfunction
It is a very serious and difficult to treat complication, poor prognosis, multiple secondary to severe complex liver injury, long-term shock after a large number of blood loss, blocking the long-term blood flow to the liver, severe abdominal infection, etc., therefore, timely Correcting shock, paying attention to blocking blood flow to the liver, correctly treating liver wounds, and setting up effective abdominal drainage to prevent infection is an important measure to prevent this multiple organ failure. It is also the best treatment for multiple organ failure.
Symptom
Symptoms of liver injury Common symptoms Abdominal pain, cold sweat, bloating, peritoneal irritation, blood pressure, decreased pulse oxygenation, lack of liver, atrophy, pale, abdominal muscle, tension, hepatocyte fat,
The clinical manifestations of liver injury are mainly intra-abdominal hemorrhage and blood, bile-induced peritoneal irritation, depending on the type and severity of the injury.
(1) True liver laceration
Slightly damaged and less bleeding, self-stop, abdominal signs are also light, severe damage has a large amount of bleeding and shock, the patient pale, cold hands and feet, cold sweat, pulse speed, and then blood pressure, such as combined bile duct fracture, then Bile and blood stimulate the peritoneum, causing abdominal pain, abdominal muscle tension, tenderness and rebound tenderness, and sometimes bile sweat stimulates the diaphragmatic muscles to have hiccups and shoulder pain.
(2) Hepatic subcapsular laceration
Most of them have subcapsular hematoma. The clinical manifestations are not typical when the injury is not heavy. Only the liver area or right upper abdomen is painful, the right upper quadrant is tender, the liver area is sore, sometimes the liver is tender and there is no hemorrhagic shock. Peritoneal irritation, if secondary infection, the formation of abscess, due to continued bleeding, subcapsular hematoma gradually increased, increased tension, after several hours or a few days can be ruptured, a series of symptoms and signs of true liver laceration.
(3) Central type liver laceration
The formation of hematoma in the deep, the symptoms are not typical, such as intrahepatic bile duct laceration, blood into the biliary tract and duodenum, manifested as paroxysmal biliary colic and upper gastrointestinal bleeding.
Examine
Liver injury examination
(1) Diagnostic abdominal puncture This method is of great value in diagnosing rupture of intra-abdominal organs, especially for severe organ laceration. Generally, splanchnic injury may be considered if blood is not coagulated, but there may be false negatives when the amount of bleeding is small. As a result, a negative puncture can not exclude visceral injury, if necessary, multiple punctures at different sites, at different times, or for abdominal diagnosing to help diagnose.
(B) Timing measurement of red blood cells, hemoglobin and hematocrit to observe its dynamic changes, if there is progressive anemia, suggesting internal bleeding.
(C) B-mode ultrasound examination This method can not only find blood in the abdominal cavity, but also help the diagnosis of hepatic subcapsular hematoma and intrahepatic hematoma, which is more commonly used in clinical practice.
(4) X-ray examination If there is hepatic subcapsular hematoma or intrahepatic hematoma, X-ray or fluoroscopy can be seen that the liver shadow is enlarged and the diaphragm is elevated. If the underarm free gas is found at the same time, it is suggested that the hollow organ is merged. damage.
(5) Liver radionuclide scanning diagnosis is not clear closed injury, suspected hepatic subcapsular or intrahepatic hematoma, the injury is not very urgent, the patient's condition allows for isotope liver scan, hematoma in the liver Table shows the existing radioactive defect area.
(6) Selective hepatic angiography for some closed injuries that are difficult to diagnose, such as suspected intrahepatic hematoma, the injury is not very urgent, this method can be used to see the diagnosis of intrahepatic artery branch aneurysm formation or contrast agent spillover. Signs of meaning, but this is an invasive examination, the operation is more complicated, can only be carried out under certain conditions, and can not be used as a routine inspection.
Diagnosis
Diagnosis and identification of liver injury
Open injury, according to the location of the wound, the depth and direction of the wound, the diagnosis of liver damage is more difficult, closed true liver laceration, the diagnosis of obvious intra-abdominal hemorrhage and peritoneal irritation is not difficult, only under the capsule Hepatic laceration, subcapsular hematoma and central type laceration may be difficult to diagnose liver laceration when symptoms and signs are not obvious. Comprehensive analysis should be made in combination with injury and clinical manifestations, and changes in vital signs and abdominal signs should be closely observed.
Combined with medical history and auxiliary examination, it is easy to confirm the diagnosis, pay attention to identify the type of injury, and pay attention to the identification of damage in other organs of the abdominal cavity.
