الفهرس 
HEPATIC SURGICAL ANATOMYOnly 14 pages are availabe for public view
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Abstract
T
he liver and biliary tree develops as a hollow endodermal bud, the hepatic diverticulum, from the distal foregut in the 3-week embryo. The rapidly proliferating cells of the bud penetrate the septum transversum and eventually develop into the liver, while the connection between the hepatic diverticulum and the foregut is preserved to form the bile duct.
The liver can be injured by sudden acceleration, deceleration, strong compressive forces or Rapid increases in internal fluid pressure. The most common causes are road traffic accidents, sport injuries and falling objects.
Examination is divided into general and local examination, general examination include rapid primary survey (Airway, breathing, circulation, disability, and exposure) with resuscitation.
Abdominal pain and tenderness are the most frequent findings. Abdominal rigidity, or involuntary guarding is the most helpful sign in examination.
Investigation of hepatic trauma by Laboratory Investigations (Leukocytic count; Hematocrit value; Coagulation profile; Serum amylase; hepatic enzymes).
Imaging (Plain film evaluation; Ultrasonography; Computerized tomography). Cause of death in hepatic trauma (Hemorrhage; Sepsis and abscess; Biliary leakage).
Treatment of hepatic trauma by Resuscitation of patient Fluid resuscitation is achieved through two large-bore intravenous cannulas, one in each cubital fossa.
Non operative management (NOM) of blunt liver injury has generally become the most frequent treatment.
Patients who are hemodynamically stable continuously from the time of trauma through evaluation in the emergency center are ideal candidates for nonoperative management of a hepatic injury. Other patients who are modestly hypotensive (systolic blood pressure < 120 mm Hg and > 90 mm Hg) upon arrival and who respond to the rapid infusion of crystalloid solutions without further hypotensive episodes are considered to be hemodynamically stable in most centers and are candidates for nonoperative therapy.
General principles of nonoperative management: Maintain high index of clinical suspicion. Always keep the mechanism of injury in mind. Patient should be examinable, with clear mental status. Patient should be hemodynamically stable, with no obvious operative indications. Be cautious when committing to nonoperative management in multiply injured patients. Adequate healthcare team resources must be available (ability to perform frequent physical exams, re-imaging, and repeat the laboratory). Appropriate setting for nonoperative observation is available (observation ward, intensive care unit, monitored emergency department bed). Operative management should be available and instituted promptly if indicated by signs/symptoms.
Interventional radiology has been one of the most important advances in trauma in the past few decades. It has successfully been used as an adjunct to surgery and as the main definitive treatment modality for both blunt and penetrating trauma.
The selection of patients for angiographic intervention is based on clinical examination and CT scan findings.
The practice of damage control laparotomy has become widely accepted as a standard strategy in the management of unstable patients with severe abdominal trauma complicated by coagulopathy, acidosis and hypothermia.
Techniques of repair of hepatic injuries: Suture, Hepatoraphy, Topical agents (Fibrin glue; Extensive hepatorrhaphy), hepatotomy with selective vascular ligation, Omental pack, resectional debridement with selective vascular ligation, anatomical resection, selective hepatic artery ligation, mesh wrapping, perihepatic packing, intrahepatic tamponade and liver transplantation.