liver rupture
Introduction
Introduction to liver rupture Liver rupture is a common disease in abdominal trauma, and the right liver ruptures more than the left liver. The liver is located on the right side of the lower axilla and the deep ribs. It is protected by the thoracic and diaphragmatic muscles and is generally not easily damaged. However, due to the fragility of the liver, the blood vessels are rich, and it is fixed by the surrounding ligaments, it is also vulnerable to external violence or sharp stab wounds. Causes rupture and bleeding. When the liver is swollen due to a lesion, it is more susceptible to injury when subjected to external force. Hepatic injury often has severe hemorrhagic shock, and biliary peritonitis and secondary infections are caused by bile leakage into the abdominal cavity. The treatment of the operation is to temporarily control the bleeding, as soon as possible to identify the injury, once the surgery is decided, the abdominal cavity should be quickly opened. Try to control the time of bleeding. The surgical incision should be large enough to fully reveal the liver. After entering the abdominal cavity, it is often due to bleed. Affect the exploration of injuries. At this point, the surgeon should quickly circumscribe the thin catheter or thin band in the duodenal ligament, tighten it, and block the blood flow into the liver. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock biliary peritonitis
Cause
Cause of liver rupture
Cause:
The liver is the largest substantial organ in the abdominal cavity. It is fragile and prone to injury. In various abdominal injuries, liver rupture accounts for 15-20%. Hepatic rupture is divided into primary liver rupture and secondary liver rupture. Most of the hepatic rupture hemorrhage is the rupture of primary liver cancer, but a small part of it is a benign liver mass and cirrhotic nodule rupture. This disease is caused by external force or trauma after the liver itself is damaged.
Pathophysiology:
Pathological classification of liver trauma: 1 liver rupture: liver capsule and parenchymal laceration. 2 subcapsular hematoma: parenchymal laceration but intact capsule. 3 Central type laceration: deep parenchymal laceration, with or without a capsule laceration. Subhepatic rupture also has the potential to turn into a true rupture, but central rupture of the liver is more likely to develop into a secondary liver abscess. According to the extent and extent of the damage. Hepatic trauma was divided into six degrees, and III, IV, V, and VI degrees were severe liver trauma.
Prevention
Liver rupture prevention
1. Rest in bed, control diet, apply painkillers, hemostatic agents and antibiotics, and closely observe pulse, respiration, blood pressure and general condition.
2, open damage should first be filled with clean cloth and bandage to stop bleeding.
3, shock patients should take the supine position, the head is slightly lower, pay attention to keep warm and keep the airway open, and rushed to the hospital for emergency treatment.
4. After the above emergency treatment, the hospital should be sent to the hospital for emergency surgery.
Complication
Hepatic rupture complications Complications, shock, biliary peritonitis
Hepatic injury often has severe hemorrhagic shock. Hemorrhagic shock is a rare disease characterized by severe shock, encephalopathy and other symptoms of an acutely ill child, leading to death or extremely severe nervous system. Damage the result. Infants mainly occurred between 3 and 8 months (mean age is 5 months), but it has also been reported to occur at the age of 15. And biliary peritonitis and secondary infections are caused by bile leakage into the abdominal cavity.
Symptom
Symptoms of liver rupture Common symptoms Blood pressure lowering Abdominal tenderness Right upper quadrant continuous drama... Peritoneal irritation of abdominal cavity bleeding Skin pale abdominal pain accompanied by shock intra-abdominal bleeding pulse acceleration
After the liver rupture, there may be bile spilling into the abdominal cavity, so abdominal pain and peritoneal irritation are more obvious. After the liver ruptures, the blood may sometimes enter the duodenum through the bile duct and black feces or hematemesis (ie, biliary bleeding).
1. Abdominal pain: persistent severe pain in the right upper quadrant, radiating to the right shoulder.
2. Peritoneal irritation: Abdominal tenderness is obvious, muscle tension and rebound tenderness are obvious in the right upper abdomen.
3. Internal bleeding or hemorrhagic shock: such as pale skin and mucous membranes, increased pulse, decreased blood pressure, etc.
Examine
Liver rupture
The peritoneal irritation of the face (the pain in the ipsilateral shoulder) suggests an upper abdominal organ injury. The following checks can be selected depending on the condition of the condition.
Laboratory examination: When there is a serious organ rupture in the abdomen, the values of red blood cells, hemoglobin, hematocrit, etc. are significantly decreased, and the white blood cell count may be slightly increased. When the hollow organ ruptures, the white blood cell count increases significantly. In addition, you can also do: B-mode ultrasound, x-ray examination, CT examination, radionuclide scanning, diagnostic abdominal puncture and peritoneal lavage, laparoscopy.
Diagnosis
Diagnosis of liver rupture
Diagnose based on
1. The history of trauma is caused by direct violence in the right lower chest or upper right abdomen, and a small number is caused by indirect violence.
2. Abdominal pain is severe.
3. Peritoneal irritation.
4. Internal bleeding and hemorrhagic shock performance.
5. Abdominal puncture or lavage, the result is positive.
6. B-ultrasound, CT or MR examination can confirm the diagnosis.
Differential diagnosis
It is differentiated from abdominal trauma and abdominal large vessel injury.
