Hepatic injury Causes
Hepatic injury (liver injury) is caused by traumatic injury, it will generally be divided into open and closed injury. Openness in general there is a knife stab injury, gunshot wounds, etc. Relatively minor stab wound, the fatality rate low. Gunshot wounds are fired by the power of gunpowder to do the ejection objects (bullets, shrapnel pellets) due to the openness of injury, often at war injuries, liver-fire device injured abdominal gunshot wounds are the most common injury, another opening up can be divided into the blindgut wound and penetrating wound. Blunt abdominal trauma found to blunt injury, mainly due to impact, squeeze caused by common in road traffic accidents, buildings collapse, occasionally falling in height, sports injury or assault injury.Because of blunt abdominal trauma in addition to liver trauma often combined other organ injury and abdominal injuries surface without signs, diagnosis is relatively difficult to have some cause treatment delays, therefore the more dangerous blunt injuries, the fatality rate is often higher than the open injury.
Liver trauma early pathophysiological changes is bleeding, hemorrhagic shock and bile peritonitis mainly of the latter not only add to the loss of extracellular fluid and may affect the normal clotting mechanism, caused by secondary bleeding and infection.
The pathological changes of liver damage due to the nature of injury vary. Stab wounds and cuts caused by hepatic parenchymal injury are relatively light. Bullet and shrapnel often caused by penetrating injuries or blind wound, the degree of injury and injury location and speed are closely related to the warhead. Usually by representatives of the following formula:
Medium m-projection-type damage, v-projection speed. Style can be seen from the projection on the speed of a little increase in kinetic energy was generated by the square of the increase. In addition, the shrapnel is not the damage caused by warping is also grows. Along the trajectory of high-speed bullet damage, liver tissue allows the separation off.
Often the site of liver laceration in the liver around the ligament attachment or with the ribs, spine toward consensus. Blunt hepatic trauma caused by the following three kinds of major injury.
1. Hepatic subcapsular hematoma of the surface rupture of the liver parenchyma and the liver capsule is still incomplete, while the blood accumulate in the subcapsular. Hematoma size, and sometimes that can accommodate 2 ~ 4L blood, if the secondary infection, the abscess formation. Once the capsule ruptured, the rupture of liver to polycythemia. Hepatic parenchymal hematoma sometimes oppression, caused by large areas of necrosis in liver tissue.
2. Liver central rupture of hepatic parenchymal injury in the central part of the surface rupture of the Organization is still incomplete, there is often accompanied by liver rupture of blood vessels and bile duct, leading to higher intrahepatic hematoma and bile retention, oppression organizations can also be caused by extensive necrosis secondary to infection or with the large intrahepatic bile duct communication, concurrency hemobilia.
3. Polycythemia liver rupture liver parenchyma and liver were ruptured capsule, blood and bile to flow directly into the abdominal cavity, but the degree of injury and pathological changes vary greatly, can be divided into:
Inside and outside the liver to make bile duct injury can be spillover, resulting in biliary peritonitis. Hilar vascular injury is caused by hepatic ischemia and acute intra-abdominal hemorrhage.