Ruptured hepatic capsular hematoma

Introduction The rupture under the capsule, the rupture of the liver parenchyma under the capsule, and the formation of the subdural hematoma is a kind of liver rupture. The liver rupture refers to the rupture of the liver caused by the blunt action. Since the external force acts directly on the liver area, the liver is squeezed between the anterior and posterior abdominal wall and the spine, or the body can be damaged by acceleration, deceleration, and torsion during exercise.

Cause

The liver is caused by a swollen lesion or an external force. The liver is generally not susceptible to trauma due to the protection of the right quarter rib cage and diaphragm and the perfect fixation of the ligament. Similarly, due to the fragility of liver tissue, especially when the liver is swollen due to lesions, if it is subjected to strong violence, it can often cause extensive liver damage, accompanied by severe hemorrhagic shock, plus biliary peritonitis due to bile overflow and subsequent A systemic infection.

an examination

Related inspection

Tumor acoustic contrast A fetal globulin test

(A) mainly due to intra-abdominal hemorrhage and peritoneal irritation. After the occurrence of true liver rupture, a lot of blood loss in the abdominal cavity causes shock; blood and bile flow into the abdominal cavity to stimulate the peritoneum to cause severe abdominal pain and right abdominal muscle tension, tenderness, rebound tenderness and mobile dullness; blood and bile stimulate the diaphragm Hiccups and right shoulders involve pain and progressive aggravation. Hepatic subcapsular tearing is generally limited by the amount of bleeding, often liver distension, discomfort, pain and touch, slamming pain, no peritoneal irritation and hemorrhagic shock, hematoma formed by deeper rupture, except for compression of hepatocytes , outside the bile duct is easy to concurrent infection, the formation of liver abscess, so that the right diaphragm muscle activity is limited, inhalation pain; if the intrahepatic bile duct rupture, blood can flow into the duodenum through the biliary tract, manifested as upper gastrointestinal bleeding Secondary biliary system infection, severe sepsis can occur, manifested as high fever, pain, jaundice, disturbance of consciousness.

(B) The physical examination of the liver is enlarged, the abdomen has a mobile dullness, and the liver dull area is enlarged.

Differential diagnosis

Identification:

Hepatic membrane tension: The surface of the liver and spleen is covered with a film called "film", and nerves are distributed in the membrane. When the liver spleen is swollen, it will inevitably squeeze the capsule and pull the nerve to cause pain.

diagnosis:

(A) mainly due to intra-abdominal hemorrhage and peritoneal irritation. After the occurrence of true liver rupture, a lot of blood loss in the abdominal cavity causes shock; blood and bile flow into the abdominal cavity to stimulate the peritoneum to cause severe abdominal pain and right abdominal muscle tension, tenderness, rebound tenderness and mobile dullness; blood and bile stimulate the diaphragm Hiccups and right shoulders involve pain and progressive aggravation. Hepatic subcapsular tearing is generally limited by the amount of bleeding, often liver distension, discomfort, pain and touch, slamming pain, no peritoneal irritation and hemorrhagic shock, hematoma formed by deeper rupture, except for compression of hepatocytes , outside the bile duct is easy to concurrent infection, the formation of liver abscess, so that the right diaphragm muscle activity is limited, inhalation pain; if the intrahepatic bile duct rupture, blood can flow into the duodenum through the biliary tract, manifested as upper gastrointestinal bleeding Secondary biliary system infection, severe sepsis can occur, manifested as high fever, pain, jaundice, disturbance of consciousness.

(B) The physical examination of the liver is enlarged, the abdomen has a mobile dullness, and the liver dull area is enlarged.

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