Liver injury

　　This disease is caused by external violence.

　　After the liver is subjected to blunt force, different types of liver lacerations can be caused depending on the magnitude of the force. The mild ones are superficial lacerations with little bleeding, some of which can stop spontaneously; the severe ones are deeper lacerations, some irregularly star-shaped or even severely fragmented, losing vitality or falling into the abdominal cavity. This type of injury is mainly manifested as intra-abdominal hemorrhage and hemorrhagic shock. Blood has a certain刺激性 to the peritoneum, which can cause mild peritoneal irritation symptoms. If there is a rupture of the bile duct, bile leakage can cause severe signs of choleperitonitis. If the main trunk of the hepatic vein, the posterior segment of the inferior vena cava behind the liver, or the main branches of the portal vein are injured, there can be continuous massive bleeding, leading to shock quickly, and even rapid death. The liver tissue that has lost vitality or scattered in the abdominal cavity will necrose and decompose, along with accumulated blood and bile, which can lead to secondary bacterial infection and form an abdominal abscess. Subcapsular lacerations of the liver due to the integrity of the capsule, the liver parenchyma rupture and bleeding accumulate under the capsule to form a hematoma. Mild injuries have little bleeding and small hematomas, some of which can be absorbed spontaneously; severe injuries have more bleeding and can widely separate the liver capsule to form a large hematoma, and the pressure of the hematoma can also cause necrosis of the surrounding liver cells. Hematomas can also become infected and form abscesses. High-tension hematomas can rupture the capsule and become true lacerations. Central-type liver lacerations are mainly deep liver parenchyma rupture, while the liver capsule and superficial liver parenchyma remain intact. This type of laceration can form a large hematoma in the deep liver, causing the liver volume to increase and tension to rise, and the surrounding tissue of the hematoma to be compressed and necrotic. This hematoma can break into the abdominal cavity to form internal hemorrhage and peritonitis, or break into the bile duct to manifest as biliary hemorrhage, or become infected and form a liver abscess.

　　The severity of open and penetrating injuries depends on the location of liver injury and the penetration speed of the causative agent. When bullets and shrapnel penetrate liver tissue, they can transfer energy to the surrounding tissue of the trajectory, causing destruction. When major hepatic vessels are injured, the actual liver damage may not be severe, but due to continuous massive bleeding, there is still a high mortality rate. In addition to the type of injury and the extent of injury, the presence of multiple organ injuries is an important factor affecting the mortality rate of liver trauma. The more organs involved, the more severe the injury, the more difficult the treatment, and the higher the mortality rate.

　　1. Infectious complications

　　It includes liver abscess, subdiaphragmatic abscess, and incision infection, etc. Thoroughly removing necrotic liver tissue and contaminants, properly stopping bleeding, and placing reliable and effective drainage are effective measures to prevent infection. Once abscesses form, they should be drained in a timely manner.

　　2. Bile leakage from liver wound

　　It can lead to choleperitoneum or localized peritoneal abscess, which is also a relatively serious complication. The method to prevent bile leakage is to carefully ligate or suture the broken large and small bile ducts during surgery and place a drainage tube. After bile leakage occurs, placing a 'T' tube for drainage in the common bile duct can reduce the pressure in the bile duct and promote healing.

　　3. Secondary hemorrhage

　　It is often caused by improper wound management, leaving dead spaces or necrotic tissue, leading to secondary infection, causing vessel rupture or suture line fall-off and rebleeding. When there is a large amount of bleeding, reoperation is needed to stop bleeding and improve drainage.

　　4. Acute liver-kidney-lung dysfunction

　　It is an extremely serious and difficult-to-handle complication with poor prognosis. It often occurs after severe combined liver injury, prolonged shock after a large amount of blood loss, excessive blockage of blood flow to the liver, and severe abdominal infection. Therefore, timely correction of shock, attention to the duration of blockage of blood flow to the liver, proper management of liver wounds, and effective abdominal drainage are important measures to prevent multiple organ failure, and the best treatment for multiple organ failure at present.

　　One, true liver laceration

　　Minor injuries have less bleeding and can stop spontaneously, and abdominal signs are also mild. Severe injuries may lead to a large amount of bleeding and shock, with the patient's face pale, hands and feet cold, cold sweat, rapid and thin pulse, followed by a decrease in blood pressure. If the bile duct is also broken, bile and blood stimulate the peritoneum, causing abdominal pain, muscle tension, tenderness, and rebound pain. Sometimes, bile stimulation of the diaphragm may cause hiccups and shoulder radiation pain.

　　Two, subcapsular liver laceration

　　Most have subcapsular hematoma, and the clinical manifestations are not typical when the injury is not severe, only with abdominal pain in the liver area or upper right abdomen, tenderness in the upper right abdomen, percussion tenderness in the liver area, and sometimes palpable liver with tenderness. There is no hemorrhagic shock and obvious peritoneal irritation. If secondary infection occurs, abscesses may form. Due to continuous bleeding, the subcapsular hematoma gradually increases in size, the tension increases, and it may rupture after several hours or days, resulting in a series of symptoms and signs of true liver laceration.

　　Three, central type liver laceration

　　Blood clots form in the deep layer, and the symptoms are not typical. If there is also an injury to the intrahepatic bile duct, blood flows into the bile duct and duodenum, presenting with paroxysmal biliary colic pain and upper gastrointestinal bleeding.

　　1. This disease is caused by external violence, and there is no effective preventive measure. In daily work and life, we should try to avoid the impact of external violence.

　　According to traditional Chinese medicine, factors such as decreased physical fitness, drinking, food accumulation, depression, overeating of rich and sweet foods, and others may lead to changes in the liver.

　　Vegetables are commonly used in people's lives, rich in nutrients, beneficial, and can be eaten regularly. Vegetables are not only rich in vitamins but also contain a large amount of dietary fiber, lignin, organic acids, inorganic salts, and other substances, which are essential nutrients for the recovery process of liver patients.

　　What kind of food is good for the body when suffering from liver injury:

　　1. It is good to eat vegetables and fruits containing vitamins for liver injury. The intake of vitamins can improve the symptoms of vitamin deficiency such as dry skin, night blindness, and hemorrhage in patients, and at the same time, it also helps the regeneration of liver cells, which is very beneficial to the improvement of the condition of patients with liver injury.

　　2. It is good to eat foods containing protein for liver injury. Proteins are metabolized and decomposed in the human body to produce various amino acids, which can ensure the normal operation of various organs and tissues, and at the same time, they can promote the repair and regeneration of liver cells, improve liver function.

　　After the diagnosis of liver laceration is clear, it should strive for early surgical treatment. The injured patients mostly have internal hemorrhage and hemorrhagic shock, and some also have injuries to other organs. Preoperative anti-shock treatment is very important, which can improve the injured patients' tolerance to anesthesia and surgery. Firstly, a reliable and effective blood transfusion route should be established, and it is more appropriate to choose the superior vena cava branch as the blood transfusion route. Because some external injuries are accompanied by inferior vena cava laceration, blood transfusion from the lower extremities may be blocked or leaked out, and the effect of replenishing blood volume cannot be achieved. Some severe liver injuries are accompanied by rupture of large blood vessels, with a large amount of bleeding. Although active and rapid massive blood transfusion is carried out, the blood pressure still cannot rise and stabilize. At this time, one should make a decisive decision immediately. While intensifying anti-shock treatment, abdominal exploration should be performed to control active bleeding. After the shock improves, further surgical treatment should be carried out.

　　The surgical management principles for liver trauma are to achieve complete hemostasis, remove non-vital fragmented liver tissue, and establish peritoneal drainage to prevent secondary infection. Hemostasis is the key to the management of liver trauma, and whether bleeding can be effectively controlled directly affects the mortality rate of liver trauma. Non-vital fragmented liver tissue will necrose and decompose, and the accumulated blood and bile will eventually lead to secondary infection, forming peritoneal abscesses.

　　One. Treatment of true liver laceration

　　There are many methods of hemostasis, and when there is a lot of bleeding, the hepatic pedicle can be blocked first, and then one of the following methods can be selected according to the specific condition of the trauma.

　　1. Simple suture method:

　　It is suitable for regular linear liver lacerations. Generally, a 4-0 silk suture or 1-0 catgut suture is used to pass a thin, long needle to perform an '8' shape or mattress suture through the bottom of the wound. The suture should be applied with lightness and gentleness to prevent the suture from cutting the liver tissue. If there is oozing from the needle holes, it can be stopped with hot saline gauze compression.

　　2. Debridement:

　　For large and deep liver lacerations, it is necessary to first remove non-vital liver tissue, ligate the ends of the blood vessels or bile ducts in the wound, and suture the active bleeding points in the liver tissue with an '8' shape to stop the bleeding. After hemostasis is completed, if the liver wound is closed and a dead space remains in the deep part, it is not advisable to simply close it. It can be left open, covered with a pedicled omentum, or the omentum can be inserted to eliminate the dead space before being closed, and drainage should be established.

　　3. Hepatic artery ligation:

　　If hemostasis is still not effective according to the above methods, consider ligating the common hepatic artery or the hepatic artery branch on the injured side. Bleeding originating from the hepatic artery can achieve good hemostatic effects.

　　4. Liver resection:

　　Bleeding from severe fragmented liver injuries is often difficult to control, and liver resection can be performed to remove non-vital liver tissue for complete hemostasis. It is generally not necessary to perform regular resection according to the anatomical divisions of the liver. Hemostasis can be controlled using tourniquets, liver clamps, or hand compression, and non-vital liver tissue is resected. The blood vessels and bile ducts on the incision surface are ligated separately, and the liver incision surface is covered with a pedicled omentum or adjacent ligament, and finally, drainage is established.

　　5. Packing hemostasis method:

　　When there is still widespread bleeding or hemorrhage after treating with methods such as suture, ligation of the hepatic artery, and compression with hot saline gauze pads, the condition of the injured person is quite critical. Large pieces of gelatin sponge, hemostatic powder, or soluble gauze can be used to fill the wound and compress the bleeding. If satisfactory hemostasis is still not achieved, large gauze strips or pads can be used to apply pressure for hemostasis. Postoperative prophylactic antibiotics and hemostatic agents should be used, and the gauze pads or strips should be removed in stages in the operating room after the condition stabilizes for 3 to 5 days. Packing hemostasis is an emergency measure that can only be used when all other hemostatic measures fail, as it is prone to secondary infection, leading to secondary hemorrhage or bile leakage and other serious complications.

　　II. Treatment of Subcapsular Hepatic Hematoma

　　Mostly due to the continued bleeding of the liver tissue that has been lacerated, the tension of the liver capsule becomes increasingly large, eventually causing the capsule剥离 surface to expand or rupture. During surgery, the capsule should be incised, the hematoma cleared, the bleeding points ligated or sutured, and the laceration sutured, and drainage installed.

　　III. Treatment of Central Liver Lacerations

　　This type of injury causes the liver capsule and superficial liver parenchyma to be intact, making diagnosis difficult. If the liver volume increases and the capsule tension increases during surgical exploration, it should be suspected that there may be a central liver rupture. Generally, liver puncture aspiration, intraoperative puncture造影, or selective hepatic artery angiography can be used to help with diagnosis. If there is a large dead space and hematoma, incision and debridement, hemostasis, and drainage should be performed. If the laceration is severe and ligation and suture hemostasis cannot be effective, consider packing the omentum after ligation and suture or partial liver resection.

　　IV. Treatment of Penetrating Liver Wounds

　　If the injury is not linear, a catheter can be placed into the wound channel through the entrance or exit to suction or rinse with physiological saline to remove blood clots, foreign bodies, and fragmented liver tissue. If bleeding has stopped, the wound generally does not need to be sutured, and drainage can be placed near the entrance and exit. If there is a large dead space and active bleeding within the wound channel, incision and debridement, hemostasis, and drainage should be performed.

　　V. Treatment of Injury to the Posterior Inferior Vena Cava Segment or Hepatic Vein Trunk

　　There is a risk of large blood loss and air embolism, but it is not easy to diagnose, and it is extremely difficult to stop bleeding by direct suture. When there is still a large amount of bleeding after the above procedures are completed, it should be considered that there may be an injury to the inferior vena cava or hepatic vein. The operation can be carried out as follows: use gauze pads to apply pressure to the laceration to control bleeding, extend the incision between the 7th and 8th right ribs, flip up the liver and expose the second liver hilum, block the blood flow of the hepatic duodenal ligament and control the blood flow above and below the inferior vena cava incision, and repair the ruptured hepatic vein trunk or inferior vena cava under direct vision to restore the blocked blood flow.