Liver trauma: A comprehensive review of classification, mechanisms, early management and surgical treatment.
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The document outlines the evaluation and management of liver trauma in children. The liver is prone to blunt injury due to its friable parenchyma and fixed position. Most liver injuries in children are caused by deceleration or crush injuries from blunt trauma. Hemodynamic stability guides management, with conservative treatment sufficient for most grades I-III injuries. Operative treatment is considered for grades IV-V or if the patient is unstable. The mortality rate for liver trauma has significantly decreased over the past century with advances in care.
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LIVER INJURY- TRAUMA SURGERY.pptx
In this presentation, I discussed the mechanism of injury, grading, clinical features, diagnosis, and treatment of liver injuries.
Liver trauma
Management of traumatic liver injuries can be either operative or non-operative. Non-operative management is now the standard of care for hemodynamically stable patients with blunt hepatic trauma. Complications may occur in 12-14% of non-operatively managed patients and include re-bleeding, biliary complications, abscesses, and thromboembolic diseases. Operative management is indicated for hemodynamically unstable patients or those with severe injuries requiring surgery. Temporary control of hemorrhage during surgery can be achieved through manual compression, perihepatic packing, or the Pringle maneuver.
Pancreatic Trauma
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
Liver trauma
The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
3) Classification systems for grading liver injuries based on CT imaging findings.
4) Treatment approaches including non-operative management with observation for lower grade injuries or angioembolization for bleeding, and operative management using packing, Pringle maneuver, and resection for higher grade or unstable injuries.
Liver and Biliary Trauma
A 19-year-old male presented with a road traffic accident injury involving blunt trauma to the abdomen. On examination, he had signs of liver and possible bile duct injury. Imaging revealed a laceration in segments V, VI, and VII of the liver along with hemoperitoneum. The patient underwent surgery where buttress sutures were applied to the liver laceration and packing was done. Post-operatively, the patient developed a bile leak. ERCP revealed a lateral rent in the common bile duct, which was stented successfully. The patient's bile leak resolved and he was discharged four days later.
Liver trauma
The liver is frequently injured in abdominal trauma due to its location and size. Most liver injuries can be managed non-operatively through observation, though some require procedures to control bleeding. The severity of injury is graded on a scale of I to VI. For blunt trauma patients who are hemodynamically stable without ongoing bleeding, non-operative management is preferred with monitoring and CT scans. Surgical management is used for unstable patients or those with significant bleeding, and focuses on controlling bleeding through sutures, packing, or clamping blood vessels.
Splenic trauma - Causes, Complications, Management
The document discusses splenic trauma, including anatomy, mechanisms of injury, signs and symptoms, diagnostic modalities, grading systems, and treatment approaches. It notes that non-operative management is the preferred treatment for hemodynamically stable patients, regardless of injury grade. Operative management may be required for hemodynamic instability, failure of non-operative management, or high-grade injuries involving major vessels. Splenectomy is performed as a last resort, and vaccination and antibiotic prophylaxis are important after splenectomy to prevent infection.
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LIVER INJURY- TRAUMA SURGERY.pptx
In this presentation, I discussed the mechanism of injury, grading, clinical features, diagnosis, and treatment of liver injuries.
Liver trauma
Management of traumatic liver injuries can be either operative or non-operative. Non-operative management is now the standard of care for hemodynamically stable patients with blunt hepatic trauma. Complications may occur in 12-14% of non-operatively managed patients and include re-bleeding, biliary complications, abscesses, and thromboembolic diseases. Operative management is indicated for hemodynamically unstable patients or those with severe injuries requiring surgery. Temporary control of hemorrhage during surgery can be achieved through manual compression, perihepatic packing, or the Pringle maneuver.
Pancreatic Trauma
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
Liver trauma
The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
3) Classification systems for grading liver injuries based on CT imaging findings.
4) Treatment approaches including non-operative management with observation for lower grade injuries or angioembolization for bleeding, and operative management using packing, Pringle maneuver, and resection for higher grade or unstable injuries.
Liver and Biliary Trauma
A 19-year-old male presented with a road traffic accident injury involving blunt trauma to the abdomen. On examination, he had signs of liver and possible bile duct injury. Imaging revealed a laceration in segments V, VI, and VII of the liver along with hemoperitoneum. The patient underwent surgery where buttress sutures were applied to the liver laceration and packing was done. Post-operatively, the patient developed a bile leak. ERCP revealed a lateral rent in the common bile duct, which was stented successfully. The patient's bile leak resolved and he was discharged four days later.
Liver trauma
The liver is frequently injured in abdominal trauma due to its location and size. Most liver injuries can be managed non-operatively through observation, though some require procedures to control bleeding. The severity of injury is graded on a scale of I to VI. For blunt trauma patients who are hemodynamically stable without ongoing bleeding, non-operative management is preferred with monitoring and CT scans. Surgical management is used for unstable patients or those with significant bleeding, and focuses on controlling bleeding through sutures, packing, or clamping blood vessels.
Splenic trauma - Causes, Complications, Management
The document discusses splenic trauma, including anatomy, mechanisms of injury, signs and symptoms, diagnostic modalities, grading systems, and treatment approaches. It notes that non-operative management is the preferred treatment for hemodynamically stable patients, regardless of injury grade. Operative management may be required for hemodynamic instability, failure of non-operative management, or high-grade injuries involving major vessels. Splenectomy is performed as a last resort, and vaccination and antibiotic prophylaxis are important after splenectomy to prevent infection.
Bile duct injury
This document discusses safe laparoscopic cholecystectomy and management of bile duct injuries. It begins with an overview of laparoscopic cholecystectomy and the increased risk of bile duct injury compared to open procedures. It then covers bile duct injury mechanisms, classifications, prevention techniques such as obtaining the critical view of safety, and management strategies whether the injury is recognized intraoperatively or postoperatively. The key messages are that obtaining the correct anatomical views and following established safety procedures can help prevent bile duct injuries, and injuries need to be promptly addressed either by repair or biliary reconstruction to reestablish bile flow.
Splenic Trauma by Doctor Saleem
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Liver trauma
1. Liver injuries are commonly caused by blunt or penetrating abdominal trauma. The right lobe of the liver is most frequently injured.
2. Liver injuries are graded from I to VI based on severity. Grade I injuries involve small lacerations while grade VI involve major vascular injuries.
3. Most liver injuries can now be managed non-operatively with techniques like angiography, embolization, and close monitoring. Operative management is reserved for higher grade injuries or those with ongoing bleeding.
Liver trauma
This document discusses liver trauma, including:
- The liver is prone to blunt injury due to its friable parenchyma and fixed position. Right lobe injuries are more common.
- Mechanisms of injury include blunt trauma from the ribs/spine, high-velocity bullets, stab wounds, and medical procedures.
- Associated injuries occur in 45% of blunt trauma cases and 33% with rib fractures.
- Injuries range from subcapsular hematomas to lacerations to devascularization. Severe injuries take 9-15 months to heal.
- Clinical signs include blood loss, abdominal tenderness, and delayed abscess. Imaging like CT scan is used to diagnose and monitor healing.
Liver Trauma
The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
liver injury
1. The liver is the second most commonly injured organ in abdominal trauma after the spleen. Liver injuries have a high mortality rate, especially with blunt trauma.
2. Liver injuries can be caused by blunt trauma from motor vehicle accidents or falls, as well as penetrating trauma from stab wounds or gunshots.
3. CT scanning is the gold standard for evaluating liver injuries and assessing their severity based on the American Association for the Surgery of Trauma (AAST) grading scale.
4. Management depends on the patient's stability and injury grade. Lower grade injuries may be managed non-operatively but higher grades often require surgery or angiography with embolization.
RENAL INJURY-ABDOMINAL TRAUMA.pptx
Renal injuries can occur from either blunt or penetrating abdominal trauma. Blunt injuries are more common and cause 90% of renal injuries. Injuries are classified from Grade I to Grade V based on severity. Minor injuries (Grades I-II) can often be managed non-operatively with monitoring but major injuries (Grades III-V) may require surgery, especially if there is continued bleeding or other serious injuries. Complications can include bleeding, infection, urinomas, and long term issues like hypertension if not properly treated. Surgery is aimed at repairing or removing injured portions of the kidney while preserving functioning tissue.
Liver trauma
The document discusses liver trauma, including:
- Liver injuries occur in approximately 5% of trauma admissions and the liver's anatomy makes it susceptible to injury.
- Comprehensive knowledge of hepatic anatomy is essential to managing liver injuries, including understanding the liver's lobes, vasculature, and ligamentous attachments.
- Liver injuries are classified based on their severity; while most stable patients can now be managed non-operatively, unstable or higher grade injuries may require surgery or other interventions.
- Diagnosis involves tools like ultrasound, CT scans, and diagnostic peritoneal lavage to identify injuries and guide management approaches.
Bile Duct Injury and Post Cholecystectomy Biliary Stricture
Bile duct injuries are a devastating complication of gallbladder surgery that can have tremendous physical and mental effects on both surgeons and patients. Early recognition within 72 hours allows for minimal inflammation and the highest chance of successful repair. Diagnosis involves signs of abdominal pain and jaundice along with imaging and blood tests showing bile leakage and liver dysfunction. Management depends on the severity and location of the injury, ranging from endoscopic stenting to immediate surgical repair.
Damage control surgery
Damage control surgery involves rapidly controlling hemorrhage and contamination through temporary measures like packing wounds, then closing the patient and allowing their physiology to stabilize in the ICU before returning to the operating room for definitive surgery. It aims to prevent hypothermia, acidosis, and coagulopathy that can result from long or complicated operations. Indications include an inability to achieve hemostasis, combined organ injuries, anticipated long procedures, or signs of declining physiological reserve like a temperature below 34°C or pH below 7.2. The principles are to control bleeding, prevent contamination, and avoid further injury through abbreviated surgical techniques.
Bile duct injuries in Laparocsopic cholecystectomy
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
Laparoscopic cholecystectomy: complex cases and challenges, 2018, by R. Lunev...
Laparoscopic cholecystectomy: complex cases and challenges, 2018, by R. Lunev...Raimundas Lunevicius
No residual calculi seen
Cases / challenges / scenario 48
Laparoscopic completion cholecystectomy
- Adhesiolysis
- Opening of the stump
- Large calculus removed
- Closure of the stump
- Uneventful recovery
Histology:
- Residual calculus in the stump
- Chronic inflammation
Take home message:
- Consider residual calculi in symptomatic patients post STC
- MRCP may miss small residual stones
- Completion cholecystectomy is a valid option
Cases / challenges / scenario 49Liver resection indications & methods
This document provides information on liver resection techniques and methods. It discusses the history and indications for liver resection, preoperative assessment including future liver remnant assessment, portal vein embolization to augment the liver volume, and surgical techniques for vascular control and parenchymal transection including the Pringle maneuver, water jet dissection, CUSA, and radiofrequency devices. The key steps in liver resection are preoperative planning, intraoperative assessment, inflow and outflow control, low central venous pressure, and parenchymal transection using various techniques and instruments.
Management of duodenal trauma
1) Duodenal injuries are uncommon and difficult to diagnose and repair due to the duodenum's retroperitoneal location. The mortality rate for duodenal injuries is high.
2) Diagnosis of duodenal injuries requires a high index of suspicion as there is no single, fully accurate diagnostic test. CT scans, upper GI studies, and exploratory laparotomy can help diagnose duodenal injuries.
3) Treatment depends on the grade of the duodenal injury. Lower grade injuries may be treated with primary closure, tube duodenostomies, or jejunal patching. Higher grade injuries involving complete wall disruption may require duodenal resection or diversion procedures like duodenal divertic
Abdominal trauma
1) Abdominal trauma can result from blunt or penetrating injuries and requires prompt evaluation and treatment to save lives.
2) Clinical signs of abdominal trauma include abdominal pain, distension, discoloration, and shock. Specific signs indicate injuries to organs like the liver or spleen.
3) Evaluation involves visual examination, palpation of the abdomen, and consideration of internal injuries to organs. Imaging like CT scans or ultrasound can help diagnose injuries.
4) Initial management consists of stabilizing the patient, controlling bleeding, giving IV fluids and oxygen, dressing wounds, and monitoring for signs of internal bleeding or injury before determining if surgery is needed.
Abdominal trauma : an overview
1. Abdominal trauma is commonly encountered in emergency departments and can be life-threatening. Blunt and penetrating injuries can cause damage to solid organs like the spleen, liver, and pancreas.
2. A thorough primary and secondary survey is essential to identify injuries. Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy help evaluate injuries. Conservative management is appropriate for many mild organ injuries.
3. Splenic injuries require close monitoring or surgery depending on grade. Liver injuries often stop bleeding spontaneously but may require packing or resection. Pancreatic injuries are difficult to diagnose and usually repaired surgically. Proper identification and treatment of abdominal injuries is critical for patient outcomes.
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This document discusses extralevator abdominoperineal excision (ELAPE) for rectal cancer. It describes how ELAPE aims to improve on conventional abdominoperineal resection (APR) by removing a larger volume of tissue, including the levator muscles, to obtain clear margins. Meta-analyses have found ELAPE results in lower rates of circumferential resection margin involvement, local recurrence, and involved nodes compared to APR. However, ELAPE also increases morbidity risks and requires perineal wound reconstruction. While ELAPE shows potential oncological benefits, more high-quality studies are still needed to prove its superiority over selective approaches.
Renal trauma
This document provides an overview of renal trauma, including epidemiology, modes of injury, classification systems, diagnostic evaluation, disease management, and complications. It discusses the American Association for the Surgery of Trauma renal injury grading scale and recommendations for initial patient evaluation, laboratory tests, and imaging modalities like CT, US, and IVP. Treatment options include conservative management with observation, angioembolization for bleeding injuries, and surgical exploration for hemodynamic instability or high-grade injuries. The goal is to control hemorrhage while salvaging the kidney through reconstruction when possible.
Liver Trauma & Concepts in Abdominal Trauma Lecture
This document summarizes information about liver trauma, including:
- Epidemiology of liver injuries, which often occur with other injuries like spleen or rib fractures.
- Relevant anatomy of the liver, including its large size, friable tissue, and location making it prone to blunt trauma.
- Classification system for grades of liver injuries from 1 to 6 based on severity.
- Modern management primarily involves conservative non-operative treatment using CT scans and angiography, reserving surgery for more severe bleeding or injuries.
- Key concepts discussed are damage control surgery, the "death triangle" of hypothermia, coagulopathy and acidosis to avoid, and total vascular exclusion for severe bleeding control
Biliary stricture ppt
Biliary stricture is an abnormal narrowing of the bile duct. The most common cause is injury during cholecystectomy, accounting for 80% of non-malignant strictures. Bile duct injury can cause inflammation, fibrosis, scarring, and cirrhosis. Surgical treatment depends on when the injury is recognized, with immediate repair during surgery or delayed repair weeks later being options. Roux-en-Y hepaticojejunostomy is a common repair method that involves a mucosa-to-mucosa anastomosis of the bile duct to the jejunum. Factors like multiple prior repairs, proximal strictures, and surgeon inexperience can lead to poor outcomes.
Ventral hernia management
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
Liver trauma
This document presents a case of traumatic liver injury in a 17-year old male patient who was in a motorcycle accident. He presented with abdominal pain and vomiting. Imaging showed a liver laceration and bleeding in the abdomen. He underwent an exploratory laparotomy where a left lobe liver laceration and diaphragm perforation were found and repaired. He recovered well after surgery with drain removal after one week and was discharged. Traumatic liver injuries can range from minor injuries treated non-operatively to severe injuries requiring surgery like lobectomy or packing to control bleeding. Both non-operative and surgical management were discussed.
Liver trauma
The liver is prone to injury due to its fixed position in the abdomen. Liver trauma can be caused by blunt or penetrating injuries from accidents or assaults. Blunt trauma may cause lacerations or hematomas while penetrating injuries pose risks of bleeding. Symptoms include right upper quadrant pain and tenderness. CT scans can diagnose lacerations while peritoneal lavage detects internal bleeding. Large lacerations require surgery while some small lacerations can be monitored. Complications include bleeding, infection, and organ dysfunction. Nursing focuses on pain management, monitoring for worsening conditions, and addressing anxiety through education and medication.
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Liver trauma
1. Liver injuries are commonly caused by blunt or penetrating abdominal trauma. The right lobe of the liver is most frequently injured.
2. Liver injuries are graded from I to VI based on severity. Grade I injuries involve small lacerations while grade VI involve major vascular injuries.
3. Most liver injuries can now be managed non-operatively with techniques like angiography, embolization, and close monitoring. Operative management is reserved for higher grade injuries or those with ongoing bleeding.
Liver trauma
This document discusses liver trauma, including:
- The liver is prone to blunt injury due to its friable parenchyma and fixed position. Right lobe injuries are more common.
- Mechanisms of injury include blunt trauma from the ribs/spine, high-velocity bullets, stab wounds, and medical procedures.
- Associated injuries occur in 45% of blunt trauma cases and 33% with rib fractures.
- Injuries range from subcapsular hematomas to lacerations to devascularization. Severe injuries take 9-15 months to heal.
- Clinical signs include blood loss, abdominal tenderness, and delayed abscess. Imaging like CT scan is used to diagnose and monitor healing.
Liver Trauma
The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
liver injury
1. The liver is the second most commonly injured organ in abdominal trauma after the spleen. Liver injuries have a high mortality rate, especially with blunt trauma.
2. Liver injuries can be caused by blunt trauma from motor vehicle accidents or falls, as well as penetrating trauma from stab wounds or gunshots.
3. CT scanning is the gold standard for evaluating liver injuries and assessing their severity based on the American Association for the Surgery of Trauma (AAST) grading scale.
4. Management depends on the patient's stability and injury grade. Lower grade injuries may be managed non-operatively but higher grades often require surgery or angiography with embolization.
RENAL INJURY-ABDOMINAL TRAUMA.pptx
Renal injuries can occur from either blunt or penetrating abdominal trauma. Blunt injuries are more common and cause 90% of renal injuries. Injuries are classified from Grade I to Grade V based on severity. Minor injuries (Grades I-II) can often be managed non-operatively with monitoring but major injuries (Grades III-V) may require surgery, especially if there is continued bleeding or other serious injuries. Complications can include bleeding, infection, urinomas, and long term issues like hypertension if not properly treated. Surgery is aimed at repairing or removing injured portions of the kidney while preserving functioning tissue.
Liver trauma
The document discusses liver trauma, including:
- Liver injuries occur in approximately 5% of trauma admissions and the liver's anatomy makes it susceptible to injury.
- Comprehensive knowledge of hepatic anatomy is essential to managing liver injuries, including understanding the liver's lobes, vasculature, and ligamentous attachments.
- Liver injuries are classified based on their severity; while most stable patients can now be managed non-operatively, unstable or higher grade injuries may require surgery or other interventions.
- Diagnosis involves tools like ultrasound, CT scans, and diagnostic peritoneal lavage to identify injuries and guide management approaches.
Bile Duct Injury and Post Cholecystectomy Biliary Stricture
Bile duct injuries are a devastating complication of gallbladder surgery that can have tremendous physical and mental effects on both surgeons and patients. Early recognition within 72 hours allows for minimal inflammation and the highest chance of successful repair. Diagnosis involves signs of abdominal pain and jaundice along with imaging and blood tests showing bile leakage and liver dysfunction. Management depends on the severity and location of the injury, ranging from endoscopic stenting to immediate surgical repair.
Damage control surgery
Damage control surgery involves rapidly controlling hemorrhage and contamination through temporary measures like packing wounds, then closing the patient and allowing their physiology to stabilize in the ICU before returning to the operating room for definitive surgery. It aims to prevent hypothermia, acidosis, and coagulopathy that can result from long or complicated operations. Indications include an inability to achieve hemostasis, combined organ injuries, anticipated long procedures, or signs of declining physiological reserve like a temperature below 34°C or pH below 7.2. The principles are to control bleeding, prevent contamination, and avoid further injury through abbreviated surgical techniques.
Bile duct injuries in Laparocsopic cholecystectomy
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
Laparoscopic cholecystectomy: complex cases and challenges, 2018, by R. Lunev...
Laparoscopic cholecystectomy: complex cases and challenges, 2018, by R. Lunev...Raimundas Lunevicius
No residual calculi seen
Cases / challenges / scenario 48
Laparoscopic completion cholecystectomy
- Adhesiolysis
- Opening of the stump
- Large calculus removed
- Closure of the stump
- Uneventful recovery
Histology:
- Residual calculus in the stump
- Chronic inflammation
Take home message:
- Consider residual calculi in symptomatic patients post STC
- MRCP may miss small residual stones
- Completion cholecystectomy is a valid option
Cases / challenges / scenario 49Liver resection indications & methods
This document provides information on liver resection techniques and methods. It discusses the history and indications for liver resection, preoperative assessment including future liver remnant assessment, portal vein embolization to augment the liver volume, and surgical techniques for vascular control and parenchymal transection including the Pringle maneuver, water jet dissection, CUSA, and radiofrequency devices. The key steps in liver resection are preoperative planning, intraoperative assessment, inflow and outflow control, low central venous pressure, and parenchymal transection using various techniques and instruments.
Management of duodenal trauma
1) Duodenal injuries are uncommon and difficult to diagnose and repair due to the duodenum's retroperitoneal location. The mortality rate for duodenal injuries is high.
2) Diagnosis of duodenal injuries requires a high index of suspicion as there is no single, fully accurate diagnostic test. CT scans, upper GI studies, and exploratory laparotomy can help diagnose duodenal injuries.
3) Treatment depends on the grade of the duodenal injury. Lower grade injuries may be treated with primary closure, tube duodenostomies, or jejunal patching. Higher grade injuries involving complete wall disruption may require duodenal resection or diversion procedures like duodenal divertic
Abdominal trauma
1) Abdominal trauma can result from blunt or penetrating injuries and requires prompt evaluation and treatment to save lives.
2) Clinical signs of abdominal trauma include abdominal pain, distension, discoloration, and shock. Specific signs indicate injuries to organs like the liver or spleen.
3) Evaluation involves visual examination, palpation of the abdomen, and consideration of internal injuries to organs. Imaging like CT scans or ultrasound can help diagnose injuries.
4) Initial management consists of stabilizing the patient, controlling bleeding, giving IV fluids and oxygen, dressing wounds, and monitoring for signs of internal bleeding or injury before determining if surgery is needed.
Abdominal trauma : an overview
1. Abdominal trauma is commonly encountered in emergency departments and can be life-threatening. Blunt and penetrating injuries can cause damage to solid organs like the spleen, liver, and pancreas.
2. A thorough primary and secondary survey is essential to identify injuries. Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy help evaluate injuries. Conservative management is appropriate for many mild organ injuries.
3. Splenic injuries require close monitoring or surgery depending on grade. Liver injuries often stop bleeding spontaneously but may require packing or resection. Pancreatic injuries are difficult to diagnose and usually repaired surgically. Proper identification and treatment of abdominal injuries is critical for patient outcomes.
Extra Levator Abdomino Perineal Resection
This document discusses extralevator abdominoperineal excision (ELAPE) for rectal cancer. It describes how ELAPE aims to improve on conventional abdominoperineal resection (APR) by removing a larger volume of tissue, including the levator muscles, to obtain clear margins. Meta-analyses have found ELAPE results in lower rates of circumferential resection margin involvement, local recurrence, and involved nodes compared to APR. However, ELAPE also increases morbidity risks and requires perineal wound reconstruction. While ELAPE shows potential oncological benefits, more high-quality studies are still needed to prove its superiority over selective approaches.
Renal trauma
This document provides an overview of renal trauma, including epidemiology, modes of injury, classification systems, diagnostic evaluation, disease management, and complications. It discusses the American Association for the Surgery of Trauma renal injury grading scale and recommendations for initial patient evaluation, laboratory tests, and imaging modalities like CT, US, and IVP. Treatment options include conservative management with observation, angioembolization for bleeding injuries, and surgical exploration for hemodynamic instability or high-grade injuries. The goal is to control hemorrhage while salvaging the kidney through reconstruction when possible.
Liver Trauma & Concepts in Abdominal Trauma Lecture
This document summarizes information about liver trauma, including:
- Epidemiology of liver injuries, which often occur with other injuries like spleen or rib fractures.
- Relevant anatomy of the liver, including its large size, friable tissue, and location making it prone to blunt trauma.
- Classification system for grades of liver injuries from 1 to 6 based on severity.
- Modern management primarily involves conservative non-operative treatment using CT scans and angiography, reserving surgery for more severe bleeding or injuries.
- Key concepts discussed are damage control surgery, the "death triangle" of hypothermia, coagulopathy and acidosis to avoid, and total vascular exclusion for severe bleeding control
Biliary stricture ppt
Biliary stricture is an abnormal narrowing of the bile duct. The most common cause is injury during cholecystectomy, accounting for 80% of non-malignant strictures. Bile duct injury can cause inflammation, fibrosis, scarring, and cirrhosis. Surgical treatment depends on when the injury is recognized, with immediate repair during surgery or delayed repair weeks later being options. Roux-en-Y hepaticojejunostomy is a common repair method that involves a mucosa-to-mucosa anastomosis of the bile duct to the jejunum. Factors like multiple prior repairs, proximal strictures, and surgeon inexperience can lead to poor outcomes.
Ventral hernia management
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
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Liver trauma
This document presents a case of traumatic liver injury in a 17-year old male patient who was in a motorcycle accident. He presented with abdominal pain and vomiting. Imaging showed a liver laceration and bleeding in the abdomen. He underwent an exploratory laparotomy where a left lobe liver laceration and diaphragm perforation were found and repaired. He recovered well after surgery with drain removal after one week and was discharged. Traumatic liver injuries can range from minor injuries treated non-operatively to severe injuries requiring surgery like lobectomy or packing to control bleeding. Both non-operative and surgical management were discussed.
Liver trauma
The liver is prone to injury due to its fixed position in the abdomen. Liver trauma can be caused by blunt or penetrating injuries from accidents or assaults. Blunt trauma may cause lacerations or hematomas while penetrating injuries pose risks of bleeding. Symptoms include right upper quadrant pain and tenderness. CT scans can diagnose lacerations while peritoneal lavage detects internal bleeding. Large lacerations require surgery while some small lacerations can be monitored. Complications include bleeding, infection, and organ dysfunction. Nursing focuses on pain management, monitoring for worsening conditions, and addressing anxiety through education and medication.
Liver Trauma (Liver Injury)
Liver Anatomy (basics), types of liver injuries, ingury scoring scale for liver, CT pictures of different grades, non-operative and operative managment of liver trauma.
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Liver trauma
1) Liver trauma is the second most common organ injured in blunt abdominal trauma and the most common injured in penetrating trauma, occurring in 1-8% of patients with multiple blunt trauma.
2) The liver is susceptible to injury due to its size, friable parenchyma, thin capsule, and fixed position near the ribs and spine.
3) Liver injuries are classified based on the mechanism of injury, type and degree of damage, localization within liver lobes/segments, and whether associated vessels or bile ducts are damaged. Grades I-II are minor injuries while Grades III-V require surgical intervention and Grade VI is incompatible with survival.
Liver Trauma: Classification
The document describes a standardized classification system for grading the severity of liver injuries. The classification system ranges from Grade I to Grade VI injuries, with higher grades indicating more severe injuries involving deeper lacerations, larger hematomas, and greater parenchymal disruption or vascular injuries. CT imaging is useful for evaluating the extent of injuries and assigning a grade.
Liver trauma final
The document discusses liver trauma, providing details on the anatomy and physiology of the liver, classifications of traumatic liver injuries, clinical presentations, diagnostic imaging approaches including CT scans and angiography, and treatments. Key points covered include: the liver is the second most commonly injured abdominal organ from trauma but most common cause of death; injuries are often from blunt force such as motor vehicle accidents; CT scans are the diagnostic standard and can classify injuries on a scale of I-VI based on features like hematomas and lacerations; angiography can identify active bleeding for potential embolization treatment.
LIVER TRAUMA
This document discusses liver trauma resulting from blunt and penetrating injuries. It describes two case studies, one involving a car accident and the other a stabbing. The car accident patient had liver lacerations that were managed surgically, while the stabbing victim had a liver wound and duodenal injury repaired during an emergency laparotomy. Most liver injuries can be successfully treated without surgery if the patient is hemodynamically stable. Surgical management may involve packing the liver or angiographic embolization of bleeding sites. Following initial resuscitation, imaging can help evaluate the severity and location of liver injuries.
Helminthiasis part 2 (GI tract, liver) on russian and english
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Acs0707 Injuries To The Liver, Biliary Tract, Spleen, And Diaphragm
This document discusses the assessment and treatment of injuries to the liver. It describes the anatomy and blood supply of the liver. Grading scales are used to classify the severity of hepatic injuries from minor lacerations to complete avulsion. For complex injuries, temporary control of bleeding through manual compression, perihepatic packing, or clamping the hepatic pedicle (Pringle maneuver) can provide time for resuscitation before definitive treatment.
Liver Trauma
This document discusses the evaluation and management of abdominal trauma. It notes that blunt trauma is the most common mechanism of abdominal injury, which can involve the liver, spleen, pancreas, and kidneys. Physical exam alone is often inadequate for diagnosis, as patients may be stable initially despite injuries. Bedside ultrasound and CT scan are recommended for diagnosis as they are sensitive and accurate. Management depends on the severity of injuries, with penetrating injuries typically requiring exploration while blunt injuries can sometimes be observed conservatively.
Trauma surgery 2012
This document summarizes census data from the annual trauma census in 2012. It provides an overview of 53,454 total ED visits, with 73% classified as green, 20% yellow, and 6% red. 1% of patients were brought in deceased. Of the 923 trauma surgery patients admitted under the red category, 918 were admitted and 5 were transferred out. A total of 1299 patients underwent surgery for injuries sustained from trauma. The top three causes of injury were RTI (55%), falls (25%), and assaults (16%). Most injuries were due to blunt force (90%) rather than stab wounds or gunshot wounds. The document also summarizes patient demographics, types of injuries sustained, surgical interventions performed,
Trauma renal
Este documento resume las consideraciones clínicas y de manejo para traumas urogenitales. Explica la clasificación AAST para lesiones renales (Grados I-V), con énfasis en la importancia de la estabilización inicial, evaluación por imágenes, y tratamiento quirúrgico vs conservador según el grado de lesión y hemodinámica del paciente. También cubre hallazgos operatorios comunes y reconstrucciones posibles tras trauma renal.
Liver infections and infestations
Pyogenic and amebic liver infections and infestations are described. Pyogenic liver abscesses are usually caused by bacteria spreading from another infected site via the bloodstream and are typically treated with antibiotics and drainage. Amebic liver abscesses are caused by the parasite Entamoeba histolytica and present with right upper quadrant pain, fever, and tenderness. Diagnosis involves blood tests and imaging, and treatment consists of antiparasitic medications and sometimes drainage. Hydatid cysts are caused by the tapeworm Echinococcus granulosus and seen endemic areas; they may cause liver masses, pain, or allergic reactions.
Genitourinary tract trauma
This document discusses injuries to the genitourinary tract, including the kidney, ureter, bladder, and urethra. Kidney injuries are often caused by trauma and present with hematuria, pain, and palpable masses. Imaging studies like CT scans are used for diagnosis. Complications include hemorrhage, hydronephrosis, and abscesses. Ureter injuries can be caused by surgery or trauma and present with anuria, oliguria, pain, and hydronephrosis. Diagnosis involves tests like retrograde uretherography and treatment includes surgeries like ureteroureterostomia. Bladder injuries from trauma or surgery can be intraperitoneal or extraper
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Este documento resume los aspectos clave del traumatismo renal. Define el traumatismo renal, su incidencia y mecanismos. Explica la clasificación de lesiones renales basada en hallazgos radiológicos y el enfoque de tratamiento, ya sea conservador o quirúrgico. También cubre el diagnóstico, complicaciones y seguimiento de pacientes con traumatismo renal.
Review urotrauma
The document reviews urological trauma, focusing on renal trauma. It provides details on the epidemiology, classification, investigations, and management of renal trauma. Key points include:
- Renal trauma accounts for 1-5% of all trauma cases and is most commonly caused by blunt mechanisms like motor vehicle collisions.
- CT scan with IV contrast is the standard imaging investigation, while angiography is recommended for persistent bleeding.
- Conservative management is recommended for stable patients with low grade injuries. Higher grade injuries or instability may require angiography or surgery.
- Operative intervention is indicated for hemodynamic instability, expanding hematomas, or high grade vascular injuries. Renal reconstruction should be attempted when possible.
Cystic diseases of liver includes pyogenic . amoebic and the hydatid diseases
This document discusses cystic diseases of the liver, classifying them into infectious, congenital, neoplastic, and traumatic hepatic cysts. It focuses on infectious cysts including pyogenic liver abscess, amebic liver abscess, and hydatid cyst of the liver. For each condition, it covers epidemiology, etiology, pathology, clinical presentation, diagnosis, treatment including antibiotics, drainage and surgery, and complications. Surgical drainage is currently reserved for patients that have failed nonoperative therapy or those with multiple macroscopic abscesses.
10 genitourinary trauma
This document discusses genitourinary trauma. It covers renal trauma in detail, including that renal injuries make up about 10% of emergency room visits for trauma. It presents the American Association for the Surgery of Trauma classification system for renal injuries in detail. It also discusses trauma to the bladder and ureters, management principles, and complications.
Spleen Trauma
The document summarizes information about the spleen, including its anatomy, development, location in the body, blood supply, histology, and functions. It then discusses splenic trauma and injuries, describing grading scales for injuries and treatment approaches. For minor injuries, nonoperative management is often adequate but more severe injuries may require splenectomy or partial resection to control bleeding.
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Acs0707 Injuries To The Liver, Biliary Tract, Spleen, And Diaphragm
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Cystic diseases of liver includes pyogenic . amoebic and the hydatid diseases
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Similar to Liver trauma: A comprehensive review of classification, mechanisms, early management and surgical treatment.
abdominal solid organ injuries
Blunt abdominal trauma commonly causes injuries to solid organs like the liver, spleen, and kidneys. The liver is most frequently injured due to its location and size. Non-operative management is successful for over 90% of liver injuries, but patients may require angioembolization, ERCP, or surgery for bleeding, bile leaks, or infection. While splenectomy was once standard, non-operative management is now successful for over 65% of splenic injuries through observation, angioembolization, or splenic repair/wrapping during surgery. Complications of solid organ injuries include bleeding, infection, and bile leaks if non-operative management fails.
PANCREATIC INJURY.ppt.pptx
The document discusses pancreatic injury, providing details on:
- The anatomy, blood supply, and innervation of the pancreas.
- Epidemiology of pancreatic injury, which most often results from blunt or penetrating abdominal trauma.
- Mechanisms of injury depend on whether the trauma is blunt or penetrating.
- Grading systems classify injuries based on severity and ductal involvement.
- Management involves conservative treatment for minor injuries but surgery is often needed for more severe injuries or ductal disruption, such as distal pancreatectomy.
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Genito-urinary trauma
This document discusses urinary tract trauma, focusing on kidney injuries. It notes that kidney injuries account for 67% of GU trauma and are usually blunt. CT scan is the preferred imaging modality. The Federle and AAST classification systems for renal injuries are described, grading injuries from I-V in severity. Grade I are minor injuries like contusions. Higher grades involve deeper lacerations, vascular injuries, and devascularized or shattered kidneys. CT findings for each grade are provided with examples. Other imaging modalities like ultrasound, IVU, and angiography are also discussed.
Abdominal trauma ,an overview
1) Abdominal trauma is commonly encountered and can be life-threatening. Identification of serious intra-abdominal injuries can be challenging.
2) Motor vehicle accidents account for 60% of abdominal trauma, with blunt trauma more common than penetrating injuries.
3) Injuries to solid organs like the spleen, liver, and kidneys require careful assessment and may be graded based on severity. Conservative management is often attempted initially if the patient is stable.
4) Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy can help identify injuries, but repeated examinations are often necessary. Management may involve surgery or conservative approaches depending on injury severity and patient stability.
Liver Trauma.pptx
This document provides tips and instructions for using a PowerPoint presentation on liver trauma. Some key points:
- Slides can be freely edited and modified. Blank slides are included to facilitate active learning sessions.
- The presentation follows the AAST classification system for liver injuries and also discusses the WSES classification.
- Imaging studies like CT, ultrasound, and angiography play an important role in diagnosis. Conservative management is preferred for stable patients.
- Indications for surgery include signs of peritonitis, uncontrolled bleeding, or clinical deterioration. Surgical techniques aim to control bleeding and remove devitalized tissue.
Pancreatic injury
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
Urinary tract injury (kidney injury)
Please find the power point on Urinary Tract Injury (Kidney Injury). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Renal Trauma | Diagnosis, Management and Followup
Brief description of renal trauma, Grading, its diagnostic investigations and Management Protocol.
Liver trauma الدكتور طارق المنيزل
The document provides information on liver injury including:
- Liver injury occurs in approximately 5% of trauma admissions and mortality has decreased from 62.5% to 27.7% with advances in care.
- CT scan is used to grade liver injuries from I-VI based on factors like laceration depth and presence of bleeding or vascular injury.
- 85-89% of stable patients with blunt liver injury can be managed non-operatively though complications like bile leak or abscess can occasionally occur.
Biliary injury.pdf
This document discusses injuries to the biliary tract, including the gallbladder and extrahepatic bile ducts. It notes that bile duct injuries most commonly occur during cholecystectomy and can lead to complications if not properly managed. The management of biliary tract injuries depends on the type and extent of injury, and may involve repair during surgery, postoperative stenting or drainage, or biliary-enteric reconstruction procedures. Outcomes are best when injuries are recognized and repaired immediately by an experienced surgeon.
Upper gu trauma
This document discusses genitourinary trauma, focusing on injuries to the upper and lower urinary tract. It covers the etiology, clinical findings, imaging, and management of renal injuries, ureteral injuries, and bladder injuries. Renal injuries are the most common genitourinary injuries and are often caused by blunt trauma from motor vehicle accidents. Contrast-enhanced CT is the preferred imaging method to evaluate renal injuries. Most renal injuries can be managed non-operatively with bed rest and IV fluids, while operative management is indicated for persistent bleeding or expanding hematomas.
Abdominal vascular injuries
A lecture about the management approaches for abdominal vascular injuries. Injury to the major arteries and veins in the abdomen are technical challenge to the surgeon and are often fatal. All vessels are susceptible to injury with penetrating trauma. Vascular injuries in blunt trauma are far less common and usually involve the renal arteries and veins, though all other vessels, including the aorta, can be injured. Blunt trauma results from deceleration, AP compression or pelvic fractures.
Management of penetrating renal injury
managing renal injury with focus on the penetrating variety for medical students, resident doctors and other health personnel
Role of Imaging in Abdominal Trauma.pptx
1) The document discusses the role of various imaging modalities such as FAST, CT, and MRI in evaluating abdominal trauma. FAST can rapidly detect free fluid but misses solid organ injuries while CT is the main imaging method and has high accuracy for abdominal trauma.
2) Specific injuries to organs like the spleen, liver, kidneys, bladder and bowel from blunt or penetrating trauma are described along with their characteristic imaging findings on ultrasound and CT.
3) Other topics covered include pancreatic trauma, gallbladder injuries, diaphragmatic ruptures and their signs on diagnostic imaging tests.
Urology Trauma
Renal trauma is the most common genitourinary injury, accounting for 84% of cases. The kidneys are vulnerable to blunt trauma from motor vehicle accidents or falls. Computed tomography is the gold standard for evaluation and allows grading of injuries from Grade 1 to 5 based on the extent of laceration or devitalized tissue. Most Grade 1-3 injuries can be managed conservatively with bed rest, but higher grades or hemodynamic instability may require surgical exploration or nephrectomy. Ureteric injuries are less common, usually from penetrating trauma or surgery, and often diagnosed during laparotomy for other injuries.
Bile duct injury.pptx
This document discusses the management of bile duct injuries detected during or after laparoscopic cholecystectomy. It notes that bile duct injuries are detected intraoperatively in about one-third of cases. When detected intraoperatively, immediate repair by an experienced hepatopancreaticobiliary surgeon may be considered, though delayed repair often has better outcomes due to less inflammation. For injuries detected postoperatively, initial management focuses on controlling bile leaks and sepsis before definitive repair, often a bilioenteric anastomosis, performed after 6 weeks by an hepatopancreaticobiliary surgeon once the patient is stabilized. Hepatectomy or liver transplantation may be needed for complex injuries or if secondary biliary cirrhosis develops
Renal Trauma
Renal trauma can occur from blunt or penetrating injuries. Evaluation involves stabilizing the patient, assessing for life-threatening injuries using ATLS protocols, and obtaining imaging. CT is the preferred imaging method and allows grading of injuries according to the AAST scale. Most grade I-III injuries can be managed conservatively with observation. Higher grade injuries may require angioembolization or surgery to control bleeding. Goals of management are to control hemorrhage and salvage renal tissue when possible. Patients require follow-up imaging and monitoring for early or delayed complications.
Imaging in genitourinary trauma
This document discusses genitourinary trauma, focusing on renal trauma. It notes that the kidney is the most commonly injured genitourinary organ. Renal trauma is most often blunt, with severe cases associated with injuries to other organs. CT scan is the preferred imaging modality to evaluate renal injuries according to the American Association for the Surgery of Trauma classification system, which grades injuries from I to V based on severity. Grade I injuries involve contusions or small lacerations without urine extravasation. Grade II injuries include larger lacerations or hematomas confined to the kidney. Grade III injuries involve deeper lacerations or vascular injuries with contained bleeding.
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Liver trauma: A comprehensive review of classification, mechanisms, early management and surgical treatment.
- 1. Liver Trauma
- 2. Objectives • To outline evaluation and management of Liver trauma in children
- 3. Back ground • To create a document for rapid review of this commonly encountered injury
- 5. Why the liver… • Friable parenchyma, thin capsule, fixed position in relation to spine prone to blunt injury . • Right lobe larger, closer to ribs. more injury • In children compliant ribs, transmitted force
- 6. Mechanism of injury • Deceleration injury --producing a laceration of its relatively thin capsule and parenchyma at the sites of attachment to the diaphragm • Crush injury --direct blow to the abdomen --damage to the central portion of the liver
- 7. Blunt trauma
- 9. Pearl • posterior segment of the right liver lobe is the most frequently injured part. This part also involves the bare area and this can lead to retroperitoneal bleeding rather than bleeding into the peritoneal cavity.
- 10. Associations • Isolated liver injury occurs in less than 50% of patients. • Blunt trauma 45% with spleen • Rib fracture 33% with Liver injury
- 11. Injuries • Contusion • Laceration • Subcapsular hematoma • Parenchymal damage • Hepatic vascular disruption • Bile duct injury
- 12. Grading
- 13. Grading outcomes • Grade I,II ---minor injuries, represent 80-90% of all injuries, require minimal or no operative treatment • Grade III-V -- severe, most managed conservatively but surgical intervention is occasionally needed • Grade IV --incompatible with survival
- 14. Diagnosis of liver injury • Ultrasonography --fast, accurate, noninvasive, a good initial screening test --sensitivity 88%, specificity 99 • DPL --fast, sensitive, accurate and simple to perform --invasive, cannot diagnose retroperitoneal injury
- 15. Computed tomography • The standard evaluation method for stable patient • Performed with Dilute water soluble oral contrast agent and intravenous contrast
- 16. Classification (AAST) • I-Subcapsular hematoma<1cm, superficial laceration<1cm deep.
- 17. • II-Parenchymal laceration 1-3cm deep, subcapsular hematoma1-3 cm thick.
- 18. • III-Parenchymal laceration> 3cm deep and subcapsular hematoma> 3cm diameter.
- 19. • IV-Parenchymal/supcapsular hematoma> 10cm in diameter, lobar destruction
- 20. • V- Global destruction or devascularization of the liver.
- 22. Management
- 23. Conservative treatment • 86% of liver injuries have stopped bleeding by the time of surgical exploration • 67% of operations performed are nontherapeutic • Standard method of pediatric patient for the past 20 years, with a success rate of 90%
- 24. Criteria for conservative treatment hemodynamically stable simple hepatic parenchyma laceration of inrahepatic hematoma absence of active hemorrhage limited need for liver related blood transfusions absence of peritoneal sign absence of other peritoneal injuries that would otherwise require an operation
- 25. Complications of conservative treatment Conservative treatment Delayed hemorrhage Stable CT scan Liver injury worse Angiogram Embolization Unstable Liver injury unchanged Exploration Search for other causes Hemobilia Bili Hemia Liver abscess
- 26. Operative treatment • Initial hemostasis Packing Pringle maneoevre Bimanual liver compression Cross clamping aorta above celiac trunk
- 27. Blood supply • Portal vein • Hepatic artery • Hepatic vein
- 28. Liver segments
- 29. Technique • Hepatotomy with direct suture ligation using the finger fracture technique, electrocautery or an ultrasonic dissector to expose damaged vessels and hepatic duct low incidence of rebleeding, necrosis and sepsis Resection and debridement
- 30. Surgical options Anatomical resection --reserved for deep laceration involving major vessels or bile ducts, extensive devascularization and major hepatic venous bleeding Perihepatic packing --Indication:coagulopathy, irreversible shock from blood loss , hypothermia(32C), acidosis(PH7.2), bilobar injury,large nonexpanding hematoma, capsular avulsion, vena cava or hepatic vein injuries
- 33. Mesh Wrapping
- 35. Harmonic scalpel
- 37. Tissue link
- 38. Outcome Liver regeneration post resection of the right liver The mortality rate from liver trauma has fallen from 66 per cent in World War I, to 27 per cent in World War II, to current levels of 10-15 per cent
- 39. Summary • Liver 2nd most commonly injured solid organ. • Hemodynamic stability is the principle guide to management. • Resuscitation is of primary importance rather than wasting time and blood on grading either outside or inside the theatre.
- 40. •Thank you