Clinicas quirurgicas expo

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  • 1. The Liver Liver Trauma Liver AbscessClinical Surgery DepartmentDr. Benjamin Robles MadrigalDr. Hector Manuel Vírgen AyalaFrancisco Javier Robles Saucedo
  • 2. The Liver
  • 3. Functions1) Blood2) Metabolism3) Bile4) Iron & Vitamins Deposit5) Coagulation Factors
  • 4. Liver TraumaPiercing (>50%) Proyectile, Knife.Blunt Direct Hits Explosive wounds Outbreak Lineal lacerations Sudden Deceleration
  • 5. Symptoms Blood Pressure AbdominalHipovolemic shock Diuresis distension Vein Pressure
  • 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. AbscessPyogenic(E. coli)Amebic(E. Histolytica)Exposure Routes1) Biliar Tree2) Portal vein3) Hepatic artery4) Direct extension of a nearby focus of infection5) Trauma
  • 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. Amebic Pyogenic Fever Jaundice Chill Cought & Dysnea Abdominal pain & Tenderness Leu > 15,000 Anemia (Hto 33%)
  • 10. Dx.RxCTECO
  • 11. TxDrainAntibiotics or AzolesLaparotomy