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Chapter-17 Management of Hepatic Trauma

BOOK TITLE: Principles and Practice of Trauma Care

Author
1. Kochar SK
ISBN
9789350257173
DOI
10.5005/jp/books/11942_17
Edition
2/e
Publishing Year
2013
Pages
28
Author Affiliations
1. Royal Hospital, Greenock, Scotland, UK, Army Base Hospital, New Delhi, India, Fortis Heart Institute and Multispeciality Hospital, Mohali, Punjab, India
Chapter keywords

Abstract

The incidence of hepatic injuries detected in patients undergoing laparotomy for blunt/penetrating trauma varies from 15-45 per cent at different centers. Blunt hepatic injuries can result from direct blow, compression from the injury in right lower chest or shearing at fixed points secondary to deceleration. The large size of the liver and its location in both upper quadrant of the abdomen make it vulnerable to injury in patients with penetrating wounds. The most frequent sign of injury on physical examination are profound hypotension and peritonitis. The presence of penetrating wounds, upper abdominal bruising or ecchymosis or lower chest injury may be an indication of hepatic trauma. USG of the abdomen and CT scan are the investigations of choice in haemodynmically stable patient. Haemodynamically unstable patient should be subjected to surgery with minimal investigations. The most important resuscitative technique in the patient with a major hepatic injury includes insertion of large bore intravenous lines in the upper extremities, rapid transfusion with warm crystalloid solution and type specific blood and early operation for controlling of ongoing haemorrhage. Complications and sequalae of surgery has been described. Conservative management of hepatic trauma has well defined indications and protocols. Grading of injury is based on CT scan. Management for penetrating injuries has been discussed in details.

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