Liver: trauma in Cats (Felis) | Vetlexicon
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Liver: trauma

ISSN 2398-2950


Introduction

  • Cause: common injury is blunt trauma, eg falls, gunshot wounds and road traffic accidents.
    In all cases of traumatic injury warn owner of potential complications at time of injury.
  • Occasionally a fractured rib lacerates liver.
  • Signs: concurrent injuries to other abdominal viscera; related to degree of hemorrhage: a few ml of blood loss to a massive exsanguination   →   shock.
  • Diagnosis: radiography, ultrasonography.
  • Treatment: fluid therapy, abdominal wrapping for shock; failure to improve the circulatory status will require surgical exploration of the peritoneal cavity.
  • Prognosis: good if no complications.

Presenting signs

Acute presentation

  • Sudden death (ex-sanguination).
  • Hypovolemic shock.

Special risks

Pathogenesis

Etiology

  • Blunt trauma, eg falls from heights, road traffic accidents.
  • Penetrating bite wounds.
  • Gunshot wounds.

Pathophysiology

  • Trauma to the rib cage   →   fractured rib   →   lacerate liver lobe   →   hemorrhage.
  • Trauma   →   liver rupture   →   hemorrhage, massive ex-sanguination often associated with an avulsion of a hepatic lobe from the vena cava.
  • Hepatic injury   →   ischemia to a portion of the liver   →    devitalized tissue   →    bacterial proliferation   →   local peritonitis Peritonitis or liver abscess.
  • May be other associated injuries, eg pancreatic Pancreas: trauma, thoracic injuries Thorax: trauma etc.

Timecourse

  • Usually acute though may be several days with gall bladder injuries.

Diagnosis

Presenting problems

  • Shock.

Client history

  • Trauma.

Clinical signs

  • Abdominal distension due to hemorrhage.
  • Signs associated with shock, eg tachycardia, poor pulses.
  • Pain on anterior abdominal or rib palpation.
  • Pallor.

Diagnostic investigation

Other

Radiography

  • Abdominal radiographs  Radiography: abdomen:
    • Generalized loss of abdominal detail if significant hemorrhage.
    • With small amounts of hemorrhage or inflammation due to trauma there may be a localized loss of abdominal detail (localized peritonitis).
    • Careful examination should be made for evidence of other abdominal trauma - particularly bladder or ureter rupture Ureter: trauma which may also result in ascites/peritonitis.
  • Thoracic radiographs Radiography: thorax:
    • To identify other trauma particularly pneumothorax or pleural effusions which may require management before anesthesia is considered.
    • Rib fractures are relatively common following blunt trauma.

2D Ultrasonography

  • Allows accurate assessment of severity of liver damage and number of lobes involved Ultrasonography: liver.
  • Other abdominal organs particularly bladder and kidneys should be examined to confirm integrity.
  • Ultrasound guided sampling of localized pockets of ascitic fluid may aid diagnosis.

Hematology

Biochemistry

Confirmation of diagnosis

Discriminatory diagnostic features

Definitive diagnostic features

Treatment

Initial symptomatic treatment

  • Fluid therapy Fluid therapy: overview.
    May result in continued/recurrent hemorrhage with elevation of blood pressure. Monitoring with diagnostic peritoneal lavage/tap important evidence of continuing hemorrhage.
  • Abdominal wrapping.

Standard treatment

Surgery

  • Laparotomy Laparotomy: midline.
  • Minor lacerations of the liver will respond to pressure alone.
  • Deep fractures should be debrided and closed with horizontal mattress sutures, although this has been associated with post-operative infection.
  • Temporary occlusion of the portal vein and hepatic artery (Pringle manoeuvre) can be done for 10 minutes to help control hemorrhage and improve visualization.
  • A one inch latex rubber drain as a tourniquet around the left or right lobe of the liver is also a rapid, simple, effective, and more selective method of obtaining hemostasis.
  • If the wound is too large to close, then a partial or total lobectomy should be performed or a pedicled piece of omentum can be used as a patch to fill the wound. The liver wound and omentum are oversewn with a continuous suture.

Antibiotic therapy

Monitoring

  • Hemorrhage.
  • Shock.
  • Local peritonitis.

Prevention

Outcomes

Prognosis

  • Good if hemorrhage can be controlled and shock treated rapidly and effectively.

Reasons for treatment failure

  • Post-operative infection, liver abscess, local peritonitis.
  • Uncontrolled hemorrhage.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Streeter E M, Rozanski E A, Laforcade-Buress Ad et al (2009) Evaluation of vehicular trauma in dogs: 239 cases (January-December 2001). JAVMA 235 (4), 405-408 PubMed.
  • Boysen S R, Rozanski E A, Tidwell A S et al (2004) Evaluation of a focused assessment with sonography for trauma protocol to detect free abdominal fluid in dogs involved in motor vehicle accidents. JAVMA 225 (8), 1198-1204 PubMed.
  • Vinayak A, Krahwinkel D J (2004) Managing blunt trauma-induced hemoperitoneum in dogs and cats. Comp Contin Educ Pract Vet 26 (4), 276 VetMedResource.