Management of liver injuries

The liver is one of the most commonly injured organs in abdominal trauma. Recent advancements in imaging studies and enhanced critical care monitoring strategies have shifted the paradigm for the management of liver injuries.

The liver is one among the foremost frequently injured organs in abdominal trauma. The anterior location within the abdomen and fragile parenchyma with easily disrupted Glisson’s capsule make this organ susceptible to injury. There is a paradigm shift within the management of liver trauma thanks to advancements of diagnostic and therapeutic modalities.

A few century ago, Pringle conducted an animal experiment, occluding the orifice in liver trauma while repairing the injuries. However, application of an equivalent principle in trauma victims led to high mortality. Since 1965, the introduction of diagnostic peritoneal lavage (DPL) has led to several nontherapeutic laparotomies in previously unsuspected low-grade injuries. Operative intervention in high-grade injuries may end in high mortality also.

Recent advancement of contrast-enhanced sonography improved the diagnostic accuracy in terms of conspicuity, size and completeness of the injury, as compared to non-contrast.

Computed tomography scan

CT scan is that the first imaging study which provides relatively detailed delineation of solid organ injuries and retroperitoneal injuries also. CT scan is that the standard imaging study for hemodynamically stable patients following injury. Severity of injuries is additionally graded supported CT scan examination. Extravasation of contrast demonstrated on CT scan (35–40 HU) indicates active bleeding from the injury site and further intervention is required.

Recent advancement of contrast-enhanced sonography improved the diagnostic accuracy in terms of conspicuity, size and completeness of the injury, as compared to non-contrast.

Computed tomography scan

CT scan is that the first imaging study which provides relatively detailed delineation of solid organ injuries and retroperitoneal injuries also. CT scan is that the standard imaging study for hemodynamically stable patients following injury. Severity of injuries is additionally graded supported CT scan examination. Extravasation of contrast demonstrated on CT scan (35–40 HU) indicates active bleeding from the injury site and further intervention is required.

Damage control surgery

Damage control surgery includes perihepatic packing and closure of the abdominal incision either using a Bogata bag or partial closure of proximal abdominal incision.

The interventional radiologist plays an integral role in the no operative management of liver injuries. Angiography and angioembolization has become the gold standard in the management of liver injuries for hemodynamically stable patients, if a contrast extravasation is seen on CT scan.

Extravasation of contrast during CT scans requires further intervention. Unstable patients should mandate emergency laparotomy. Direct control of bleeding vessels, vascular isolation and damage control surgery are preferred and the most popular approaches compare to anatomical resection of liver and the use of an aortocaval shunt.

Interested authors can contact through this mail: drugsafety@pharmajournals.org

Authors can submit the article in our online portal by using this link: https://www.longdom.org/submissions/advances-pharmacoepidemiology-drug-safety.html