Hepatic Trauma (Penetrating)


Background
  1. Injury to liver from penetrating trauma
  2. Most commonly injured abdominal organ with penetrating trauma
  3. More common in males
  4. Causes
  5. Morbidity, mortality

Pathophysiology

  1. Anatomy
  2. Injury Grades

Diagnostics

  1. History
  2. Symptoms
  3. Physical exam
  4. Diagnostic testing:
  5. Diagnostic imaging
      • Positive if:
        • >10 cc gross blood, enteric contents
        • Bloody lavage effluent
        • >100,000 RBC/mm3 or >500 WBC/mm3
        • Amylase >175 IU/dl
        • DPL fluid exits through CT or Foley catheters
        • Bacteria, vegetable fibers or food present

Differential Diagnosis

  1. Gallbladder injury
  2. Diaphragmatic injury
  3. Vascular injury
  4. Intestinal injury
  5. Splenic injury
  6. Pancreatic injury
  7. Kidney injury

Treatment

  1. ATLS as usual
  2. FAST scan / DPL
  3. NG tube / foley PRN
  4. Operative management if
  5. Hemodynamically stable patients
  6. Tetanus prophylaxis 0.5cc IM
  7. Consider need for antibiotics
      • Unasyn 3 g IV q6h
      • Piperacillin / tazobactam 4.5 g IV q8h
      • 2nd generation cephalosporin
        • Mefoxin
        • Cefotetan
      • Triple therapy
        • Ampicillin 2 g IV q6h PLUS
        • Gentamicin 2 mg/kg load; 1.7 mg/kg q8h PLUS
        • Metronidazole 1 g IV q12h
  8. Complications

Disposition

  1. Admit all patients