Professional Documents
Culture Documents
Liver
&
Spleen
Anatomical Consideration
B.F : 70% portal
B.D : to rt, mid & lt H.V
Form effective- pedicle
portal V & hepatic A run
with B.D. in the free edge
of the lesser omentum
Physiological Aspect
Maximum toleratable
duration of normal
liver Ischemia is one
hour
traumatised liver is
less
Therabutic aspect
Topical Hypothermia
& steroids
can increase time before
ischemia but caution
with unstable patient
cosistency of the liver
allows finger fracture
Mechanism of Injury
Majority is
BLUNT 90%
vehicular,assault & fall
??why
semisolid
nonmobile
surface area
Six grades
all are with capsular tear
avulsion is the last grade
venus injury without avulsion is the fifth
How classify according to laceration ??1
How classify according to S.C.Hematoma?2
What is the value of this staging
??3
How classify
according to the
LACERATION
more than 9 =V
four & more=IV
three&more=III
more than 1= II
less than 1 = I
lobe of
the liver
with 10 cm
REMEMBER , CLASSIFY AS
MUCH GRADE AS
AVAILABLE CRITERIA
Example
liver with subcapsular hematoma with area
more than half of the surface area
But there is avulsion
STAGE SIX NOT FOUR
IV , V and VI
USU need surgical intervention
Management of L.I 1
Non-operative
Should be:
stable hemodynamic
no peritoneal signs
no head injury
no strong indic of
laproscopy :like
retroperitoneal inj or
bowel injury
BUT BUT BUT
Management of L.I. 2
Non-operative
MUST:
c&c
close monitoring in
ICU
&
CT scan assessment
of abdomen
any miss so go to
OPERATIVE MEAN
Management of L.I
2Non-operative
Management of L.I
operative
Management of L.I
operative ( cont..)
Otherwise:
if so sever : control by compression of I.V.C.
above & below the liver with compression of
porta hepatis, then resect non viable fragment
Anatomical Consideration
Function of Spleen
Defence against pathogens
include encapsulated
organism
Extravascular reservoir
Modulation of blood cells &
.remove non viable
Theraputic consideration
delay rupture of spleen can occur 7-10days after injury
Injury lead to major B.loss
Injury allows high amount of organism to present in blood
mainly pneumococcus, electrolyte disturbance,
.hypoglycemia & DIC
Pathological spleen is more vulnerable to trauma
5 grades
all are with capsular tear
vascular is the last grade
How classify according to laceration ??1
How classify according toS.C.Hematoma?2
What is the value of this staging
??3
How classify
according to the
LACERATION ??
Completely shattered
spleen =V
four & more=IV
More than3 =III
more than 1= II
less than 1 = I
Spleen
How classify
according to
subcapsular
Hematoma???2
Less than 10%=I
10% ---50%=II
To classify properly
IV & V
USU need surgical intervention
Mechanism of Injury
Majority is BLUNT
vehicular,assault & fall
??why
semisolid
nonmobile
surface area
friable
Management of S.I.
1Non-operative
Usu.. for I,II & III
Should be :
stable hemodynamic
no peritoneal signs
no head injury
no strong indic of
laproscopy :like
retroperitoneal inj or
bowel injury
+++ age younger than 56
years
Management of S.I.
2Non-operative
MUST
c&c
close monitoring in
ICU
&
CT scan assessment
of abdomen
any miss so go to
OPERATIVE MEAN
Management of S.I.
2Non-operative
Figure 2 - This CT shows a contained splenic hematoma. This was treated by observation and gradually resolved over several weeks
Figure 8 - The splenic hematoma seen in Figure 2 has now largely resolved, without surgery.
Management of S.I.
operative
Fluid replacement & transfusion
Early exploration with splenorraphy & autologous
transfusion
Otherwise, do autologous transplantation of removed
spleen into omental pouches which can also lead to some
functional recovery so decrease infection.
Also can do urgent laparatomy & splenectomy with
preservation of some to overcome sepsis & for hope of
regeneration
Assesting by wrapping absorbable mesh & fibrillary
collagen
Immunization (if below 20) especially Antipneumococcal.
Figure 11 - This shows the successful growth of splenic implants. The splenic implants have grown into the abdominal fat