Clinical Review ABC of diseases of liver, pancreas, and biliary system

Liver and pancreatic trauma

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7289.783 (Published 31 March 2001) Cite this as: BMJ 2001;322:783
  1. I J Beckingham,
  2. J E J Krige

    The liver is the most commonly injured solid intra-abdominal organ, but injuries to the pancreas are fairly rare. The primary goal in the treatment of severe abdominal injuries is to preserve life, and management is divided into four sequential phases: resuscitation, evaluation, initial management, and definitive treatment.

    Management of major abdominal trauma

    Liver trauma

    Liver trauma constitutes a broad spectrum of injuries. The magnitude of the injury, the management requirements, and the complexity of the surgical repair are determined by the extent, anatomical location, and mechanism of injury. Blunt liver trauma is usually due to road traffic accidents, assaults, or falls from heights, and results in deceleration injuries with lacerations of liver tissue from shearing stresses. High velocity projectiles, close range shotgun injuries, and crushing blunt trauma cause fragmentation of the hepatic parenchyma with laceration of vessels and massive intraperitoneal haemorrhage. Penetrating injuries such as stab or gunshot wounds cause bleeding without much devitalisation of the liver parenchyma.

    Resuscitation

    Resuscitation follows standard advanced trauma life support principles: maintenance of a clear airway, urgent fluid resuscitation, ventilatory and circulatory support, and control of bleeding. Effective venous access should be obtained and volume replacement started immediately. The patient's blood is grouped and crossmatched, and blood samples should be sent for urgent analysis of haemoglobin concentration, white cell count, blood gas pressures, and urea, creatinine, and electrolyte concentrations. Patients should also have a nasogastric tube and urinary catheter inserted.

    Clinical features of serious liver injury

    • Hypovolaemic shock:

    • Hypotension

    • Tachycardia

    • Decreased urine output

    • Low central venous pressure

    • Abdominal distension

    Criteria for non-operative management of liver injuries

    • Haemodynamically stable after resuscitation

    • No persistent or increasing abdominal pain or tenderness

    • No other peritoneal injuries that require laparotomy

    • < 4 units of blood transfusion required

    • Haemoperitoneum <500 ml on computed tomography

    • Simple hepatic parenchymal laceration or intrahepatic haematoma on computed tomography

    A liver injury should be suspected in patients with evidence of blunt …

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