The document discusses the anatomy, functions, diseases, and management of liver injuries. It describes the liver's dual blood supply and ability to regenerate after partial resection. Evaluation and treatment of liver trauma involves resuscitation, imaging to assess injuries, and management may include suturing lacerations, resection for vascular injuries, or packing for diffuse parenchymal injuries.

1. Dr. Ashok Jaisingani

2.  Liver is largest organ in the body weighting 1.5 kg
in average 70 kg man.
 The liver parenchyma is entirely covered by thin
capsule and by visceral peritoneum on all but the
posterior surface of the liver termed as “bare
area”
 The liver is divided in to „right large lobe‟ which is
constitute three quarters of liver and „smaller left
lobe.
 Surgical resection of these lobes would be termed
as right or left lobectomy.

3.  The liver has ability to regenerate after the partial
resection.
 There are two anatomical lobes with separate
blood supply, bile duct and venous drainage.
 Liver has dual blood supply with 20% from the
hepatic artery and 80% from portal vein.

4.  Maintaining core body temperature
 pH balance and correction of lactic acidosis
 Synthesis of the clotting factors
 Glucose metabolism, glycolysis and
gluconeogenesis.
 Urea formation from protein catabolism
 Bilirubin formation from haemoglobin degradation
 Drug and hormone metabolism
 Removal of gut endotoxins and foreign antigens

5.  Viral hepatitis (hepatitis A, B, C, D, E)
 Drugs reaction [halothane, isoniazid, rifampicin,
antidepressant, NSAIDs and valproic acid]
 Paracetamole overdose
 Mushroom poisoning
 Shock and multiorgan failure
 Acute Budd – Chiari syndrome
 Wilson‟s Disease
 Fatty liver disease

6. Test Normal Range
Bilirubin 5 – 17 µmol/liter
Alkaline phosphatase (ALP) 35 – 130 IU/liter
Aspartate Transaminase (AST) 5 – 40 IU/liter
Alanine Transaminase (ALT) 5 – 40 IU/liter
Gama – glutamyl transpeptidase 10 – 48 IU/liter
(GGT)
Albumin 35 – 50 g/liter
Prothrombin time (PT) 12 – 16 sec

7.  Fluid balance and electrolytes
 Acid – base balance and blood glucose monitoring
 Nutrition
 Renal Function (Haemofiltration)
 Respiratory Support (Ventilation)
 Monitoring and treatment of cerebral edema
 Treat bacterial and fungal infection

8.  Lethargy
 Fever
 Jaundice
 Protein Catabolism (wasting)
 Coagulopathy (bruising)
 Cardiac (Hyperdynamic circulation)
 Neurological (Hepatic Encephalopathy)
 Portal hypertension [Ascites, esophageal varices
and splenomegaly]
 Cutaneous [Spider naevi, palmer erythema]

9. Imaging Modality Principle Indication
Ultrasound Standard first – line investigation
Spiral CT Anatomical planning for liver surgery
MRI Alternative to spiral CT
MRCP First – line non-invasive cholangiography
ERCP Imaging the biliary tract, when endoscopic
intervention is anticipitated (ductal stones)
PTC Biliary tract imaging when ERCP is failed or
impossible
Angiography To detect vascular involvement by tumour
Nuclear medicine To quantify biliary excretion and tumour spread
Laparoscopy/laparoscopic To detect peritoneal tumour spread and superficial
ultrasound liver metastasis

10.  Liver injuries are fortunately uncommon because of
the position of the liver under the diaphragm where it
is protected by the chest wall.
 When liver injury occurs it is serious and associated
with significant morbidity and mortality
 Liver trauma can be divided into blunt and penetrating
liver trauma.
 Blunt injuries produce contusion, laceration and
avulsion injury to the liver, often in association with
splenic, mesenteric and renal injury.
 Penetrating injury such as stab and gunshot wound
are often associated with chest or pericardial
involvement.

11.  Remember the associated injuries and at risk group such
as
1- Stabbing/gunshot in lower chest or upper abdomen
2- Crush injury with multiple rib fracture
 Resuscitate the patient (airway, breathing & circulation)
 Assessment of injury by
1- Spiral CT with contrast
2- Laparotomy if haemodynamically unstable
 Treatment consist of the
1- Correction of coagulopathy,
2- Suture laceration
3- Resect if vascular Injury
4- Packing if diffuse parenchymal injury

12.  Intrahepatic haematoma
 Liver Abscess
 Bile Collection
 Biliary Fistulae
 Hepatic Artery aneurysm
 Arteriovenous Fistulae
 Arteriobiliary fistulae
 Liver Failure