This document provides an overview of liver anatomy, physiology, and management of liver trauma. It describes the surface anatomy, blood supply, ligaments, segments, and imaging appearance of the liver. Factors making the liver prone to injury are discussed. Grades of liver injuries based on the Moore scale are outlined with examples. Non-operative and operative management strategies are reviewed, including criteria for each approach and techniques for temporary and definitive control of hemorrhage. Complications of non-operative management and indications for failure are also summarized.
Hemorrhage is the leading cause of preventable death following trauma. Non-compressible hemorrhage is of particular concern as these patients require emergent intervention and many will die prior to anatomic hemostasis. For years, left anterior thoracotomy, the “ED thoracotomy”, was the standard of care for temporary proximal aortic occlusion, but survival remained dismal. Endoluminal aortic occlusion which was actually first described in the 1950s. With the increasing use of endovascular therapies for a wide variety of vascular disease, the “REBOA” (Resuscitative Endovascular Balloon Occlusion of the Aorta) began to be reported for use for ruptured abdominal aneurysms in the 2000s. Since that time, interest in its use in trauma has been increasing with a variety of basic science studies and early clinical series and case reports documenting potential benefits. Although no large randomized trials, or even large observational studies, are available, use of the REBOA is considered standard of care in many centers. Typically the REBOA is placed via the femoral artery either percutaneously or via a cut down and the aorta is occluded with a balloon placed over a wire by standard Seldinger-type technique. The balloon can be placed in “zone 1” just above the diaphragm to provide occlusion to the abdominal viscera and pelvic vasculature or in “zone 3” at the aortic bifurcation to provide inflow control to the pelvis and lower extremities. Injuries are then addressed and the balloon is carefully deflated taking care to avoid metabolic collapse from reperfusion. One main limitation of this technique is that the currently approved device in the United States requires a 12F sheath which requires an open femoral artery repair which obvious can be associated with significant complications. There are a huge number of unanswered questions about the use of REBOA in 2015:
1. Who are the appropriate patients in whom use may be beneficial?
2. How long can a balloon be inflated and the aorta be occluded before irreversible ischemic damage to the viscera occurs?
3. How long can the aorta be occluded before the metabolic consequences of reperfusion are lethal?
4. What is the effect on cerebral and cardiac perfusion when a REBOA is placed and afterload is acutely increased? Is it favorable or “too much”?
5. Who are the appropriate providers to place a REBOA? Only surgeons? Emergency Medicine physicians? Medics in the field?
6. How do we best train providers to place the REBOA?
7. How to we assure competency of providers?
8. Will lower profile devices make the technique more accessible and be associated with fewer complications?
Presentation on New Advances in the Treatment of Liver Tumors (Laparoscopic Resections) by Dr. Kimberly Moore Dalal, Surgical Oncology & General Surgery, Peninsula Medical Center.
Variations in Hepatic Artery Anatomy and its Implications in Laparoscopic Whi...semualkaira
Pancreato-Duodenectomy (PD) is a complex procedure with significant postoperative morbidity. Oncological outcome depends
on marginal and nodal clearance around critical abdominal vasculature. The presence of aberrant vessels necessitates prompt
identification and meticulous dissection around it [1]. Although
preoperative imaging helps in appreciating proper vascular anatomy, surgeon has got a pivotal role in delineating and preserving
it without compromising oncological principles. Laparoscopic
Whipples’ procedure is done only in few experienced centers. The
role of laparoscopy has been evaluated very less so far in literature
when such vascular aberrations are present. We did a prospective
study to assess the impact presence of these variations on the laparoscopic PD
Variations in Hepatic Artery Anatomy and its Implications in Laparoscopic Whi...semualkaira
Pancreato-Duodenectomy (PD) is a complex procedure with significant postoperative morbidity. Oncological outcome depends on marginal and nodal clearance around critical abdominal vasculature. The presence of aberrant vessels necessitates prompt identification and meticulous dissection around it [1].
Variations in Hepatic Artery Anatomy and its Implications in Laparoscopic Whi...semualkaira
Pancreato-Duodenectomy (PD) is a complex procedure with significant postoperative morbidity. Oncological outcome depends on marginal and nodal clearance around critical abdominal vasculature. The presence of aberrant vessels necessitates prompt identification and meticulous dissection around it
Introduction: Liver herniation through surgical incision is very rare. Moreover, it is exceptional for the left hepatic lobe to herniate
through sternotomy incision.
Presentation of the case: We present herein a 66 year old woman admitted to ER complains about upper abdominal pain. Abdominal CT scan showed herniation of part of left hepatic lobe through previous sternotomy incision. Conservative measures were successful in managing her symptoms.
Discussion: Till now only few cases of liver herniation through scar of sternotomy have been documented.
Conclusion: Although it is rare, left hepatic lobe may herniate through sternotomy incision.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
3. Surface anatomy
In RUQ
5th
ICS in midclavicular
line to the Rt costal
margin.
Weighs 1400 g n women
and 1800g n men .
Span 10 cm +/-2
4. Surface anatomy
Superior, anterior, and right lateral surfaces
fit diaphragm.
Falciform ligament
Posterior surface
Rt lobe: colon, right kidney, and duodenum
Lt lobe: stomach
5.
6.
7. The liver covered by
fibrous capsule that
reflects on the
diaphragm and post
abdominal wall
Leaving a bear area that
connects the liver to the
retroperitoneum directly
16. Blood Supply – Portal Vein
Superior Mesentric and Splenic veins
Posterior to hepatic artery and bile duct at the
hepatodudenal junction.
Valveless
75% of total blood supply the liver
Pressure 3-5 mmHg
17. Blood supply – Hepatic artery
Intrahepatic anatomy; part of portal tried follows
segmental anatomy.
Extrahepatic anatomy; highly variable:
Commonest ( in 60%) anatomy: abdominal aorta
celiac trunk CHA proper hepatic art Rt and
Lt hepatic artery
LHA seg 1,2,3 and middle hepatic artery seg 4.
RHA cystic art , Rt liver
18.
19.
20.
21.
22.
23. Blood supply – Hepatic vein
Rt hepatic vein Drain seg 5,6,7,8 vena cava.
Middle hepatic vein Drain seg 4,5,8
Lt hepatic vein Drain seg 2,3
[ seg 1 drain by short hepatic vena cava]
28. Introduction
It is the 2nd
commonest organ injured in
blunt abdominal trauma and the
commonest injured in penetrating
trauma.
1%-8% of pt with multiple blunt trauma
sustain a liver injury.
During last 3 decades, liver injury
increased. This inc could be actual or
artificial d/t better diagnostic modalities.
Richardson JD. Ann Surg. 2000;232:324-330.
Lucas CE. Am Surg. 2000;66:337-341.
29. While small lacerations of the liver substance may
be, and no doubt are, recovered from without
operative interference:
If lacerations be extensive and vessels of any
magnitude are torn, hemorrhage will, owing to
the structural arrangement of the liver, go on
continously.
JH Pringle,
1908
30. History of Liver Trauma
WW1
WW2
Vietnam
Mortality 66%
-- 28%
-- 15%
31. Factors making the liver prone to
injury:
1. The large size of the liver,
2. its friable parenchyma,
3. its thin capsule, and
4. Its relatively fixed position in relation to the
spine and ribs.
34. Grade 1
A stabbing injury to the RUQ of the abdomen
Contrast CT demonstrates a small, crescent-shaped subcapsular and
parenchymal hematoma less than 1 cm thick.
35. Grade 2
A blunt abdominal trauma
CT scan at the level of the hepatic veins shows a subcapsular hematoma 3
cm thick.
36. Grade 3
A blunt abdominal trauma
Contrast CT shows a 4-cm-thick subcapsular hematoma associated with
parenchymal hematoma and laceration in segments 6 and 7 of the right
lobe of the liver..
37. Grade 4
A blunt abdominal trauma
CT scan of the abdomen demonstrates a large subcapsular hematoma
measuring more than 10 cm. The high-attenuating areas within the lesion
represent clotted blood
38. Grade 4
A blunt abdominal trauma
Contrast CT shows a large parenchymal hematoma in segments 6 and 7
of the liver with evidence of an active bleed. Note the capsular laceration
and large hemoperitoneum.
39. Grade 5
A motor vehicle accident
CT demonstrates global injury to the liver. Bleeding from the liver was
controlled by using Gelfoam.
45. Non-Operative Management of
Liver Injury
An absolute increase in the incidenceof
nonoperatively managed liver injuries
(NOMLI) is unequivocal.
Multiple studies have shown that
NOMLI is effective
Knudson MM. Surg Clin North Am. 1999;79:1357-1371. Malhotra AK. Ann Surg. 2000;231:804-813. Maull KI. World J Surg. 2001;25:1403-1404.
Pachter HL. Am J Surg. 1995;169:442-454. Sherman HF J Trauma. 1994;37:616-621. Schweizer W. Br J Surg. 1993;80:86-88.
. Miller PR. J Trauma. 2002;53:238-242. Goan YG. J Trauma. 1998;45:360-364. Brasel KJ. Am J Surg. 1997;174:674-677.
. Ochsner MG.. World J Surg. 2001;25:1393-1396.
46. Criteria for NOMLI
No indications for laparotomy (physical examination
signs/symptoms or other injuries)
Hemodynamically normal after resuscitation with
crystalloid
No injuries that preclude physical examination of the
abdomen (e.g., CHI, spinal cord injury)
No transfusion requirements (PRBC)
Constant availability of surgical and critical care
resources
47. Liver injury score of patients is not as
important as the hemodynamic status for
determining conservative management
48. High Success With Non-
operative Management of
Blunt Hepatic Trauma
Arch Surg. 2003;138:475-481
Hypothesis Nonoperative management
of liver injuries (NOMLI)is highly
successful and rarely leads to adverse
events.
Setting High-volume academic level I
trauma center
49. Cont.
Results
78 patients
23 (29%) were operated onimmediately, but only 12
(15%) for bleeding from the liver. NOMLI failed in
8 for reasons unrelated to the liver injury.
The success rate of NOMLI was 85% (47 of 55
patients),but the liver-specific success rate was
100%.
No adverseevents were attributed to NOMLI.
50. Cont.
Conclusions
NOMLI is safe and effective regardless of the grade
of liver injury.
Failure of NOMLI is caused by associated abdominal
injuriesand not the liver.
Fluid and blood requirements, the degreeof injury
severity, and the presence of other abdominal
organinjuries may help predict failure.
51. Complications of NOMLI
Biliary (bile peritonitis, bile leak, biloma, hemobelia..)
Infection (liver abscess, necrosis, abdominal sepsis,
SIRs)
Abdominalcompartment syndrome
Hemorrhage
Hepatic necrosis &/or Acalculous Cholecystitis
52. Failure of NOMLI
Usually attributed to reasons unrelated to liver
injury
Other injuries can be missed in a blunt trauma
victims, such as:
Bowel
Pancreas
Diaphragm
Bladder
Which can lead to failure of NOMLI
53. Criteria of failure of NOMLI
Increasing fluid requirements to maintain normal
hemodynamic status
Failed angio embolization of A-V
fistulae/pseudoaneurysm
Transfusion requirements to maintain Hct/Hgb and
normal hemodynamic status
Increasing hemoperitoneum associated with
hemodynamic liability
Peritoneal signs/rebound tenderness
54. How to manage conservatively
Grade I II III IV
ICU 0 0 0 1
Hospital stay
(d)
2 3 4 5
Activity
Restriction (w)
3 4 5 6
55. Follow up
There is no evidence supporting routine imaging (CT or
US) of the hospitalized, clinically improving,
hemodynamically stable patient.
Nor is there evidence to support the practice of keeping
the clinically stable patient at bed rest.
2003 Eastern Association For The Surgery of Trauma
56.
57. Indications
In Blunt Trauma In Penetrating Trauma
Hemodynamic
instability
Transfusion> 2 blood
volume or > 40 ml/kg
Devitalized parenchyma
Sepsis / biloma
Exploratory lapratomy
is indicated in any
penetrating trauma in
with peritoneal
penetration
58. Operative technique/options
Initial Explore Laparotomy
Temporary control of hemorrhage:
Why temp?
Ongoing hemorrhage, life threatening, no time to
restore circulatory volume.
Liver injuries not highest priority
72. Hepatic segments Resections
Right hemihepatectomy (segments 5 to 8);
AKA as Right hepatectomy or right hepatic lobectomy
Right trisectionectomy (segments 4 to 8);
AKA as Right lobectomy or Rrisegmentectomy of Starzl
Left hemihepatectomy (segments 1 to 4);
AKA as Left hepatectomy or Left hepatic lobectomy
Left lateral sectionectomy (segments 1 to 3);
AKA as Left lobectomy or Left lateral segmentectomy
73.
74.
75. References
Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 8th ed.
Sabiston Textbook of Surgery, 18th ed.
Khatri: Operative Surgery Manual, 1st ed.
ACS Surgery principles and Practice 2006.
Cameron; current surgical therapy, 8th
ed.
http://www.netterimages.com/
http://www.adhb.govt.nz
http://emedicine.medscape.com/article/370508-overview
http://www.east.org
Editor's Notes
The superior, anterior, and right lateral surfaces of the liver are smooth and convex, fitting against the diaphragm. The posterior surface has indentations from the colon, right kidney, and duodenum on the right lobe and the stomach on the left lobe
Common resections acc to the segmants:
Right hemihepatectomy (segments 5 to 8, or right hepatectomy, right hepatic lobectomy)
Right trisectionectomy (segments 4 to 8, or right lobectomy, trisegmentectomy of Starzl)
Left hemihepatectomy (segments 1 to 4, or left hepatectomy, left hepatic lobectomy)
Left lateral sectionectomy (segments 1 to 3, or left lobectomy, left lateral segmentectomy).
Common resections acc to the segmants:
Right hemihepatectomy (segments 5 to 8, or right hepatectomy, right hepatic lobectomy)
Right trisectionectomy (segments 4 to 8, or right lobectomy, trisegmentectomy of Starzl)
Left hemihepatectomy (segments 1 to 4, or left hepatectomy, left hepatic lobectomy)
Left lateral sectionectomy (segments 1 to 3, or left lobectomy, left lateral segmentectomy).
The 8 liver segments (namely 1, 2, 3, 4a, 4b, 5, 6, 7, 8) are numbered clockwise on the frontal view.
The 8 liver segments (namely 1, 2, 3, 4a, 4b, 5, 6, 7, 8) are numbered clockwise on the frontal view.