Emergency Surgery Common Disease Diagnosis and Treatment Routine

Liver rupture
Overview Liver rupture, both normal and wartime are very common, accounting for about 15% of abdominal injury 20%. Is hit by violence,
Fall or sharp weapon through the abdominal arch of the liver parenchyma tear or contusion. Can be divided into subhepatic hematoma and liver laceration liver injury
Split 0. Simple liver rupture mortality rate of about 9%, combined with multiple organ damage and complications of liver rupture rate of up to 50%
Clinical manifestations
Hemorrhagic shock is one of the main symptoms of patients with ruptured liver. Insurance is pale, thirsty, irritable, faster pulse, blood
Pressure drop and so on. Shock is the main reason for the death of patients with liver rupture in the hospital, emergency room, operating room.
2 peritonitis Most patients with liver rupture abdominal pain, abdominal distension, abdominal tenderness, rebound tenderness, muscle tension, loss of bowel sounds, evil
Heart, vomiting and other signs of peritonitis symptoms. Peripheral hemorrhage and gallbladder wounds stimulate the diaphragm, can show the right upper quadrant, right lower abdominal pain and right
Shoulder pain. Massive hematoma in the abdomen of the liver can cause severe abdominal distension, shifting dullness and rectal irritation. Subhepatic hematoma may be
No significant symptoms of seismitis symptoms, only increased liver dullness.
Diagnostic points]
1. traumatic history of blunt abdominal trauma, especially right lower chest, right waist, right quarter rib, right upper quadrant impact injury or accident; height fall
Fall injury, the right lower chest, right upper quadrant, the right quarter rib blade, projectile shrapnel through the injury, should consider the possibility of liver rupture.
2. Symptoms and signs
(1) right upper quadrant pain or tenderness, the right lower chest of the crushing pain.
(2) right shoulder radiating pain, which is due to involvement of the right diaphragm.
(3) Blunt wounded, often accompanied by lower right chest rib fractures and clinical manifestations.
(4) Hemorrhagic shock performance: hypotension, hemoglobin and hematocrit decreased.
(5) Peritonitis performance: abdominal tenderness, rebound tenderness.
3. Special inspection
(1) diagnostic abdominal paracentesis and lavage: diagnosis of diagnostic accuracy of abdominal paracentesis 80% to 90%. Most of the liver rupture, abdominal puncture
Can be drawn out without coagulation. For less damage, less bleeding in Xiamen and hemodynamic stability, abdominal irrigation can help diagnose.
(2) Abdominal B-ultrasound B-diagnosis of liver and gallbladder rupture correct rate of 99.4% e can not only correctly diagnose the cavity and retroperitoneal hemorrhage, and
Can correctly display the liver rupture site, shape, easy, economical and reliable. On the discovery of subcapsular hematoma, more helpful.
(3) abdominal CT examination: patients with hemodynamic stability should be checked, the diagnosis of liver rupture has a high specificity and sensitivity
Sensual. Can also provide a basis for non-surgical diagnosis of liver rupture.
Treatment programs and principles)
1. correct hemorrhagic shock. Quickly enter the crystal fluid and blood transfusion.
2. Non-hand wood therapy past exploration proved no or only mild active bleeding in patients with liver rupture accounted for 50% 30%. Modern fast, high quality
CT examination, to determine the location and extent of liver rupture, with or without active bleeding. So on admission some minor subhematoma or
Small lacerations. Hemodynamically stable, viable conservative treatment, and childrens non-surgical treatment of dirty ruptures have achieved very good success rates.
3 laparotomy should be carried out as soon as possible, the basic surgical technique for liver and bowls cracked wood is to completely guess the start, the exact blood, fine addition to gall bladder overflow
And establish a smooth bow drainage. First of all, to control bleeding, and then according to the degree of rupture, type, can be used separately Jingchuang hemostatic, suture,
Segmental liver or liver resection, ligation of the hepatic artery, the formation of filling parts of different ways to deal with. After surgery should be placed on the wound or liver lead cited
Flow tube to drain seepage of blood and gallbladder
4. Abdominal mesotherapy for some of the smaller subcapsular hematoma or a laceration. Hemodynamically stable, exploratory abdominal surgery
rule.
K on the set 1 All patients with liver rupture should be admitted to hospital, non-surgical treatment and postoperative benefit should be closely observed in 1C vital signs.
Aspects
i. When the liver rupture with craniocerebral injury you have a coma, loss of sexual intercourse new healthy, mental disorders and patients with drug peritonitis symptoms, body
Levy may be covered, leading to referral, Wen Zhi. Should be increased alert slow
Delayed hemorrhage is the most common complication after major treatment of liver rupture, and the treatment depends on the stability of the hemodynamics of the wounded
3. At room temperature each time blocking the liver blood flow is not strong than 0 consciousness, bitter control for a longer period of time, can be divided into.

Source: AEM Editorial Office