Legendary

1. The Liver
Liver Trauma
Liver Abscess
Clinical Surgery Department
Dr. Benjamin Robles Madrigal
Dr. Hector Manuel Vírgen Ayala
Francisco Javier Robles Saucedo

2. The Liver

3. Functions
1) Blood
2) Metabolism
3) Bile
4) Iron & Vitamins
Deposit
5) Coagulation
Factors

4. Liver Trauma
Piercing (>50%)
Proyectile, Knife.
Blunt
Direct Hits
Explosive wounds
Outbreak
Lineal lacerations
Sudden Deceleration

5. Symptoms
Blood Pressure
Abdominal
Hipovolemic shock Diuresis
distension
Vein Pressure

6. Grade Tipe Description
I Hematoma No expansion, Subcapsular, superficial area < 10%
Laceration Capsular tear, No hemorrhage, depth< 1cm
II Hematoma Subcapsular, No expansion, superficial area < 10 – 50%, in parenquima.
Laceration Capsular Tear, Active Hemorrhage, depth1 – 3cm, lenght < 10cm
III Hematoma Subcapsular, Superficial area > 50%, subcapsular tear, active hemorrhage.
Laceration Depth in parenquima > 3cm
IV Hematoma Hematoma tear in parenquima, active hemorrhage.
Laceration Parenquima rupture > 50% hepatic lobe
V Hematoma Parenquima rupture >50% hepatic lobe
Vascular Juxtaposed veins (cava or major hepatic) damage
VI Vascular Hepatic Avulsion
Dx. CT Tx.
ECO Staple
BH Debridement

7. Abscess
Pyogenic
(E. coli)
Amebic
(E. Histolytica)
Exposure Routes
1) Biliar Tree
2) Portal vein
3) Hepatic artery
4) Direct extension of a nearby focus of infection
5) Trauma

8. Clinical Features Amebic Abscess Pyogenic Abscess
Age 20 - 40 50
Male – to – Female ratio >10:1 1.5:1
Solitary vs. Multiple Solitary 80% Solitary 50%
Location Ussually right liver Ussually right liver
Travel in endemic area yes No
Diabetes Uncommon (2%) More common (27%)
Alcohol Use Common Common
Jaundice Uncommon Common
Elevated Bilirrubin Uncommon Common
Elevated alkaline Common Common
phosphatase
Positive Blood Culture No Common
Positive Amebic serology Yes No

9. Amebic Pyogenic
Fever
Jaundice
Chill
Cought & Dysnea
Abdominal pain &
Tenderness
Leu > 15,000
Anemia (Hto 33%)

10. Dx.
Rx
CT
ECO

11. Tx
Drain
Antibiotics or Azoles
Laparotomy