MyMedR

Fulltext Computed tomography (CT) in blunt liver injury: a pictorial essay

Radhiana H, Azian AA, Razali MR, Kamariah CM

Med J Malaysia, 2010 Dec;65(4):319-25.

PMID: 21901958

Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.

Matched MeSH terms: Liver/injuries*

Hepatic artery ligation in liver trauma

Radhamanalan S, Thomas I

Med J Malaysia, 1979 Sep;34(1):46-7.

PMID: 542151

Matched MeSH terms: Liver/injuries*

The sensitivity, specificity and predictive values of post mortem computed tomography in detecting liver and splenic injury due to road traffic accident

Norzailin AB, Noor Azman S, Mohd Helmee MN, Khairul Anuar Z

Med J Malaysia, 2016 02;71(1):1-7.

PMID: 27130735

OBJECTIVE: The purpose of the study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post mortem computed tomography (PMCT) in detecting liver and splenic injuries due to road traffic accidents.

MATERIAL & METHOD: 61 road traffic accidental death cases underwent both PMCT and conventional autopsy. The imaging findings were compared to the conventional autopsy findings.

RESULT: The sensitivity, specificity, PPV and NPV for liver injuries in PMCT was 71%, 82%, 68% and 85% while that of splenic injuries was 73%, 80%, 55% and 90% respectively. The accuracy of PMCT scan was 79% for both liver and splenic injuries. There is strong association between lower left ribs fracture and splenic injury (p=0.005) and significant association between positive liver and splenic PMCT finding and intraabdominal fatal injury (p=0.037).

CONCLUSION: In conclusion PMCT has high specificity and NPV for liver and splenic injuries; however the sensitivity and PPV are low. The overall accuracy is not high enough to enable PMCT to be used as a replacement for conventional autopsy; however it is a useful complementary examination and has potential to be used as decision making tool for selective internal autopsy.

Matched MeSH terms: Liver/injuries*

Fulltext Diagnosis and management of blunt pancreatic trauma: a case report with review of the literature

Khan TF, Zahari A

Med J Malaysia, 1993 Jun;48(2):244-7.

PMID: 8350806

Details of a young logger who sustained a clean prevertebral transection of the pancreas to the left of the superior mesenteric vessels and a crush injury in segments 2 and 3 of the liver are presented. CT scan was not done but ultrasound scan revealed free intraperitoneal fluid and no comment was made about the pancreas. The pancreatic injury was discovered at laparotomy carried out 24 hours after admission and treated by resection.

Matched MeSH terms: Liver/injuries*

Fulltext Blunt injuries to the liver: problems and management

Balasegaram M

Ann Surg, 1969 Apr;169(4):544-50.

PMID: 5774743

Thirty-five patients with blunt hepatic injuries treated in a 7-year period are reviewed. The difficulties of diagnosis are stressed in that only 48.6%c were diagnosed
preoperatively. Associated intra-abdominal and concomitant head, chest, pelvic and skeletal injuries accounted for most of these difficulties. Seventeen of the 35 patients had extensive lacerations or intra-lobar ruptures of the liver. Simple linear or stellate lacerated wounds were treated by drainage, or suture, or debridement of the ragged liver edges and suture. Prior to 1964 extensively lacerated liver wounds were treated by gauze packing. Three (60%c) of five patients thus treated died, while the others had multiple complications. Since 1964, packing has been abandoned in favor of major resection and of 11 patients who underwent such procedures only one died. Hepatic resection for severe blunt injuries has the advantages of removal of all devitalized liver, control of hemorrhage, reduction of postoperative complications such as secondary hemorrhage, intraabdominal and hepatic abscesses and hemobilia. Hepatic resection is recommended for subeapsular hematomas with intra-lobar rupture of the liver to avoid hepatic necrosis. These injuries are diagnosed by injection of methylene blue into the common hepatic duct. Low mortality and morbidity in this series is due to improved care of injured pa-tients, early surgical intervention and adequate removal of devitalized lacerated and injured tissues by debridement or major hepatic resection.

Matched MeSH terms: Liver/injuries*

Fulltext A preliminary study of possible prognostic factors of traumatic liver injury seen at University Hospital, 1984-1991

Sim PH, Razack AH, Jalleh RP

Med J Malaysia, 1995 Dec;50(4):346-52.

PMID: 8668055

A retrospective study was carried out on 42 patients (38 males, 4 females, mean age 25.9) with liver injury at the University Hospital, Kuala Lumpur from 1994 through to 1991. Prognostic factors that might help to identify those patient survival was related to pulse rate on arrival ( < or = 120 beats per minute, p = 0.027), systolic blood pressure at induction of anaesthesia ( > or = to 80 mmHg, p = 0.003) and intraoperative blood transfusion of < or = to 4 units (p = 0.05). This data were supported by the 95% confidence interval suggesting that these factors may be strong prognostic indicators individually. Increased mortality was also associated with increased total blood transfused (p = 0.002) and grade of liver injury (p = 0.02). Although the factors we have identified reflect both the severity of injury and resuscitative and surgical efforts, further studies using a prospective design are required to confirm these findings.

Matched MeSH terms: Liver/injuries*

Hepatic resections 1964-1979: vignettes drawn from the Malaysian experience

Balasegaram M, Joishy SK

Jpn J Surg, 1980 Jun;10(2):94-9.

PMID: 6253701

We present a study of 288 hepatic resections carried out in Malaysia for the past fifteen years. First, we describe our indications for hepatic resectins which are not limited to hepatic trauma and hepatomas, but also include hepatic abscesses, cysts, intrahepatic calculi and hemangiomas. Second, we give a simplified classification of hepatic resections using accurate terminology. Third, we describe the safety of hepatic resections in our hands which we believe is due to specially designed surgical instruments and the accurate decision making process at surgery. We have had minimum postoperative mortality and no intraoperative deaths so far. Finally, while analysing each indication we have drawn vignettes from our experience for the past fifteen years.

Matched MeSH terms: Liver/injuries

Laceration of the common hepatic duct bifurcation by blunt abdominal trauma

Muin A, Leong YP, Tay SK

Injury, 1992;23(6):422-3.

PMID: 1428177

Matched MeSH terms: Liver/injuries

Hepatic resection. Pillars of success built on the foundation of 15 years of experience

Balasegaram M, Joishy SK

Am J Surg, 1981 Mar;141(3):360-5.

PMID: 6259961

Two hundred eight-eight hepatic resections performed over the past 15 years are discussed. The safety and success achieved are attributed to the original work in Malaysia on the anatomy of the liver and its anomalies, the use of surgical instruments specially designed for hepatic resection, various types of resections devised and studies on aids to liver regeneration after resection. The diversity of the principles and practice of surgery in the Western countries compared with those in Malaysia is illustrated.

Matched MeSH terms: Liver/injuries

Complete activation of autophagic process attenuates liver injury and improves survival in septic mice

Lin CW, Lo S, Perng DS, Wu DB, Lee PH, Chang YF, et al.

Shock, 2014 Mar;41(3):241-9.

PMID: 24365881 DOI: 10.1097/SHK.0000000000000111

The accumulation of autophagosomes in the terminal step of the autophagic process has recently emerged as a potentially maladaptive process in the septic heart and lung. However, the role of autophagy in the septic liver has not been ascertained. This study was investigated by first examining the entire sequence of the autophagic process in the liver of septic mice. Second, a novel pharmacotherapeutic approach was utilized to treat sepsis with autophagy enhancer/inhibitor. Sepsis was induced by cecal ligation and puncture (CLP). C57BL/6 mice received autophagy enhancer carbamazepine (CBZ), autophagy inhibitor 3-methyladenine (inhibition of autophagosomal formation), or chloroquine (impairment of autophagosomal clearance). We found that the whole autophagic process was activated at 4 h after CLP; however, it did not proceed to completion during the 4- to 24-h time period, as indicated by accumulated autophagosomes and decreased autophagic flux. Carbamazepine, which induced complete activation of the autophagic process, improved CLP survival. This protective effect was also associated with decreased cell death, inflammatory responses, and hepatic injury. However, disruption of autophagosomal clearance with chloroquine abolished the above protective effects in CBZ-treated CLP mice. 3-Methyladenine, which resulted in inhibition of the autophagosomal formation, did not show any above beneficial effects in CLP mice. Impaired autophagosome-lysome fusion resulting in incomplete activation of autophagy may contribute to sepsis-induced liver injury. Treatment with CBZ may serve a protective role in the septic liver, possibly through the effect of complete activation of autophagic process.

Matched MeSH terms: Liver/injuries*

Biloma and biliary fistula associated with hepatorrhaphy for liver injury

Shahrudin MD, Noori SM

Hepatogastroenterology, 1997 Mar-Apr;44(14):519-21.

PMID: 9164529

To review our experience in managing post-hepatorrhaphy complications in liver trauma.

Matched MeSH terms: Liver/injuries*

Fulltext Liver injury induced by the non-steroidal anti-inflammatory drug mefenamic acid

Somchit N, Sanat F, Gan EH, Shahrin IA, Zuraini A

Singapore Med J, 2004 Nov;45(11):530-2.

PMID: 15510325

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat musculoskeletal disorders, inflammation and to control pain. Virtually all NSAIDs are capable of producing liver injury ranging from mild reversible elevation of liver enzymes to severe hepatic necrosis.

Matched MeSH terms: Liver/injuries*

Fulltext Methanol extract of Melastoma malabathricum leaves exerted antioxidant and liver protective activity in rats

Mamat SS, Kamarolzaman MF, Yahya F, Mahmood ND, Shahril MS, Jakius KF, et al.

BMC Complement Altern Med, 2013;13:326.

PMID: 24267313 DOI: 10.1186/1472-6882-13-326

Melastoma malabathricum L. (Melastomaceae) is a small shrub with various medicinal uses. The present study was carried out to determine the hepatoprotective activity of methanol extract of M. malabathricum leaves (MEMM) against the paracetamol-induced liver toxicity in rats model.

Matched MeSH terms: Liver/injuries

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