Clinicas quirurgicas expo

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Clinicas quirurgicas expo

  1. 1. The Liver Liver Trauma Liver AbscessClinical Surgery DepartmentDr. Benjamin Robles MadrigalDr. Hector Manuel Vírgen AyalaFrancisco Javier Robles Saucedo
  2. 2. The Liver
  3. 3. Functions1) Blood2) Metabolism3) Bile4) Iron & Vitamins Deposit5) Coagulation Factors
  4. 4. Liver TraumaPiercing (>50%) Proyectile, Knife.Blunt Direct Hits Explosive wounds Outbreak Lineal lacerations Sudden Deceleration
  5. 5. Symptoms Blood Pressure AbdominalHipovolemic shock Diuresis distension Vein Pressure
  6. 6. Grade Tipe DescriptionI Hematoma No expansion, Subcapsular, superficial area < 10% Laceration Capsular tear, No hemorrhage, depth< 1cmII Hematoma Subcapsular, No expansion, superficial area < 10 – 50%, in parenquima. Laceration Capsular Tear, Active Hemorrhage, depth1 – 3cm, lenght < 10cmIII Hematoma Subcapsular, Superficial area > 50%, subcapsular tear, active hemorrhage. Laceration Depth in parenquima > 3cmIV Hematoma Hematoma tear in parenquima, active hemorrhage. Laceration Parenquima rupture > 50% hepatic lobeV Hematoma Parenquima rupture >50% hepatic lobe Vascular Juxtaposed veins (cava or major hepatic) damageVI Vascular Hepatic AvulsionDx. CT Tx. ECO Staple BH Debridement
  7. 7. AbscessPyogenic(E. coli)Amebic(E. Histolytica)Exposure Routes1) Biliar Tree2) Portal vein3) Hepatic artery4) Direct extension of a nearby focus of infection5) Trauma
  8. 8. Clinical Features Amebic Abscess Pyogenic AbscessAge 20 - 40 50Male – to – Female ratio >10:1 1.5:1Solitary vs. Multiple Solitary 80% Solitary 50%Location Ussually right liver Ussually right liverTravel in endemic area yes NoDiabetes Uncommon (2%) More common (27%)Alcohol Use Common CommonJaundice Uncommon CommonElevated Bilirrubin Uncommon CommonElevated alkaline Common CommonphosphatasePositive Blood Culture No CommonPositive Amebic serology Yes No
  9. 9. Amebic Pyogenic Fever Jaundice Chill Cought & Dysnea Abdominal pain & Tenderness Leu > 15,000 Anemia (Hto 33%)
  10. 10. Dx.RxCTECO
  11. 11. TxDrainAntibiotics or AzolesLaparotomy
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