Liver is largest organ in the body weighting 1.5 kg in average 70 kg man. The liver parenchyma is entirely covered by thin capsule and by visceral peritoneum on all but the posterior surface of the liver termed as “bare area” The liver is divided in to „right large lobe‟ which is constitute three quarters of liver and „smaller left lobe. Surgical resection of these lobes would be termed as right or left lobectomy.
The liver has ability to regenerate after the partial resection. There are two anatomical lobes with separate blood supply, bile duct and venous drainage. Liver has dual blood supply with 20% from the hepatic artery and 80% from portal vein.
Maintaining core body temperature pH balance and correction of lactic acidosis Synthesis of the clotting factors Glucose metabolism, glycolysis and gluconeogenesis. Urea formation from protein catabolism Bilirubin formation from haemoglobin degradation Drug and hormone metabolism Removal of gut endotoxins and foreign antigens
Fluid balance and electrolytes Acid – base balance and blood glucose monitoring Nutrition Renal Function (Haemofiltration) Respiratory Support (Ventilation) Monitoring and treatment of cerebral edema Treat bacterial and fungal infection
Imaging Modality Principle IndicationUltrasound Standard first – line investigationSpiral CT Anatomical planning for liver surgeryMRI Alternative to spiral CTMRCP First – line non-invasive cholangiographyERCP Imaging the biliary tract, when endoscopic intervention is anticipitated (ductal stones)PTC Biliary tract imaging when ERCP is failed or impossibleAngiography To detect vascular involvement by tumourNuclear medicine To quantify biliary excretion and tumour spreadLaparoscopy/laparoscopic To detect peritoneal tumour spread and superficialultrasound liver metastasis
Liver injuries are fortunately uncommon because of the position of the liver under the diaphragm where it is protected by the chest wall. When liver injury occurs it is serious and associated with significant morbidity and mortality Liver trauma can be divided into blunt and penetrating liver trauma. Blunt injuries produce contusion, laceration and avulsion injury to the liver, often in association with splenic, mesenteric and renal injury. Penetrating injury such as stab and gunshot wound are often associated with chest or pericardial involvement.
Remember the associated injuries and at risk group such as 1- Stabbing/gunshot in lower chest or upper abdomen 2- Crush injury with multiple rib fracture Resuscitate the patient (airway, breathing & circulation) Assessment of injury by 1- Spiral CT with contrast 2- Laparotomy if haemodynamically unstable Treatment consist of the 1- Correction of coagulopathy, 2- Suture laceration 3- Resect if vascular Injury 4- Packing if diffuse parenchymal injury