scholarly journals The Evolution of Liver Injury Diagnosis and Treatment in the Past 50 Years

2014 ◽  
Vol 3 (3) ◽  
pp. 124-131
Author(s):  
Charles E Lucas
Keyword(s):  
Liver Injury ◽  
Liver Tissue ◽  
Median Sternotomy ◽  
Operative Therapy ◽  
Diagnosis And Treatment ◽  
Current Therapy ◽  
Hepatic Veins ◽  
Artery Ligation ◽  
The Past ◽  
Liver Injuries

ABSTRACT Background During the past 50 years many changes have occurred in treating liver injury. Nonoperative therapy (NOT) for blunt penetrating injuries is now common. Study design This report highlights the current therapy of liver injury. Results Complications of NOT include early rebleeding requiring prompt operative intervention; intrahepatic hematoma which becomes infected necessitating drainage; bile peritoneum requiring exploration and drainage; and hemobilia requiring embolization, hepatotomy with ligation, or resection. Operative exposure through a midline incision which can be extended as a median sternotomy is preferred. Prehepatic and intrahepatic packs are helpful. Full mobilization of the right and left triangular ligaments augments exposure. Hemostasis for both blunt and penetrating, usually, is obtained by hepatorrhaphy using the 2’ blunt tipped needle swedged onto a 2-O chromic suture. Through-and-through injuries may require hepatotomy with intrahepatic ligation of cross-linking vessels. Locally destructive wounds may require nonanatomic debridement to the point of healthy liver tissue which is then sutured. Formal segmentectomy, or lobectomy, is seldom needed. Hepatic artery ligation controls deep arterial not involving the portal venous supply. The retrohepatic caval atrial shunt will facilitate hemostasis from central liver injuries involving the hepatic veins or retrohepatic cava. Debridement of emacerated liver tissue should be extended to good liver parenchyma where deep liver sutures help with approximate the edges. Drainage is not used for minor injuries. Closed suctions are best for larger wounds. Common duct drainage should be avoided. Conclusion Most liver injuries are treated by NOT. Operative therapy involves hemostasis, debridement when necessary, and selective drainage. How to cite this article Lucas CE. The Evolution of Liver Injury Diagnosis and Treatment in the Past 50 Years. Panam J Trauma Crit Care Emerg Surg 2014;3(3):124-131.

scholarly journals Perihepatic Abscess due to a Liver Suture with Pledgets Used to Treat a Penetrating Liver Injury

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Hazuki Koguchi ◽  
Kimihiko Kusashio ◽  
Akihiro Fujita ◽  
Nao Yamamoto
Keyword(s):  
Liver Injury ◽  
Good Condition ◽  
Bile Leakage ◽  
Purulent Discharge ◽  
Duodenal Perforation ◽  
Emergency Laparotomy ◽  
Case Presentation ◽  
The Past ◽  
Liver Injuries ◽  
Selective Nonoperative Management

Background. Selective nonoperative management has become the standard for liver injuries. Accordingly, we cannot perform surgery for liver injuries as frequently as in the past. This report is aimed at sharing a valuable experience of postoperative complications after surgery for a liver injury. Case Presentation. A 40-year-old man was stabbed in his abdomen and underwent an emergency laparotomy for a severe liver injury. Five months after the operation, he developed fever, and purulent discharge was observed from an abdominal fistula. He was diagnosed with a perihepatic abscess and duodenal perforation due to the pledgets used for the operation. He underwent a second surgery to remove the pledgets and the abscess cavity for infection control and was discharged in good condition. Conclusion. The intra-abdominal environment should be considered contaminated due to bile leakage in surgeries following liver injury. Furthermore, nonabsorbable agents should not be used in these contaminated areas.

scholarly journals Immune-Mediated Drug-Induced Liver Injury: Immunogenetics and Experimental Models

2021 ◽  
Vol 22 (9) ◽  
pp. 4557
Author(s):  
Alessio Gerussi ◽  
Ambra Natalini ◽  
Fabrizio Antonangeli ◽  
Clara Mancuso ◽  
Elisa Agostinetto ◽  
...  
Keyword(s):  
Liver Injury ◽  
Experimental Models ◽  
Clinical Event ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Immune Mediated ◽  
Liver Injuries ◽  
Immunological Mechanisms ◽  
Molecular Aspects ◽  
Therapeutic Tools

Drug-induced liver injury (DILI) is a challenging clinical event in medicine, particularly because of its ability to present with a variety of phenotypes including that of autoimmune hepatitis or other immune mediated liver injuries. Limited diagnostic and therapeutic tools are available, mostly because its pathogenesis has remained poorly understood for decades. The recent scientific and technological advancements in genomics and immunology are paving the way for a better understanding of the molecular aspects of DILI. This review provides an updated overview of the genetic predisposition and immunological mechanisms behind the pathogenesis of DILI and presents the state-of-the-art experimental models to study DILI at the pre-clinical level.

scholarly journals Liver Injury and the Macrophage Issue: Molecular and Mechanistic Facts and Their Clinical Relevance

2021 ◽  
Vol 22 (14) ◽  
pp. 7249
Author(s):  
Siyer Roohani ◽  
Frank Tacke
Keyword(s):  
Bone Marrow ◽  
Liver Injury ◽  
Current Knowledge ◽  
Hepatocellular Cancer ◽  
Complete Recovery ◽  
Hepatic Macrophages ◽  
Liver Injuries ◽  
Microbial Products ◽  
Injured Liver

The liver is an essential immunological organ due to its gatekeeper position to bypassing antigens from the intestinal blood flow and microbial products from the intestinal commensals. The tissue-resident liver macrophages, termed Kupffer cells, represent key phagocytes that closely interact with local parenchymal, interstitial and other immunological cells in the liver to maintain homeostasis and tolerance against harmless antigens. Upon liver injury, the pool of hepatic macrophages expands dramatically by infiltrating bone marrow-/monocyte-derived macrophages. The interplay of the injured microenvironment and altered macrophage pool skews the subsequent course of liver injuries. It may range from complete recovery to chronic inflammation, fibrosis, cirrhosis and eventually hepatocellular cancer. This review summarizes current knowledge on the classification and role of hepatic macrophages in the healthy and injured liver.

Evidence that interaction of hepatocytes with the collecting (hepatic) veins triggers position-specific transcription of the glutamine synthetase and ornithine aminotransferase genes in the mouse liver

1991 ◽  
Vol 11 (12) ◽  
pp. 6050-6058
Author(s):  
F C Kuo ◽  
J E Darnell
Keyword(s):  
Blood Flow ◽  
Carbon Tetrachloride ◽  
Glutamine Synthetase ◽  
Liver Tissue ◽  
Mouse Liver ◽  
Hepatic Veins ◽  
Surgical Removal ◽  
Ornithine Aminotransferase ◽  
Regenerating Liver ◽  
Portal Veins

We previously demonstrated that glutamine synthetase (GS) and ornithine aminotransferase (OAT) mRNAs are expressed in the mouse liver acinus preferentially in pericentral hepatocytes, that is, those immediately surrounding terminal central veins (A.L. Bennett, K.E. Paulson, R.E. Miller, and J.E. Darnell, Jr., J. Cell Biol. 105:1073-1085, 1987, and F.C. Kuo, W.L. Hwu, D. Valle, and J.E. Darnell, Jr., Proc. Natl. Acad. Sci. USA, in press). We now show that hepatocytes surrounding large collecting hepatic veins but not portal veins also express these two mRNAs. The pericentral hepatocytes are the most distal hepatocytes with respect to acinar blood flow, whereas this is not necessarily the case for hepatocytes next to the large collecting hepatic veins. This result implies that it is contact with some hepatic venous element which signals positional expression. In an effort to induce conditions that change relationships between hepatocytes and blood vessels, regenerating liver was studied. After surgical removal of two-thirds or more of the liver, there was no noticeable change in GS or OAT expression in the remaining liver tissue during regeneration. However, treatment with carbon tetrachloride (CCl4), which specifically kills pericentral hepatocytes, completely removed GS- and OAT-containing cells and promptly halted hepatic transcription of GS. Repair of CCl4 damage is associated with invasion of inflammatory and scavenging cells, which remove dead hepatocytes to allow regrowth. Only when hepatocytes resumed contact with pericentral veins were the pretreatment levels of OAT and GS mRNA and high levels of GS transcription restored.

scholarly journals CSH guidelines for the diagnosis and treatment of drug-induced liver injury

2017 ◽  
Vol 11 (3) ◽  
pp. 221-241 ◽  
Author(s):  
Yue-cheng Yu ◽  
◽  
Yi-min Mao ◽  
Cheng-wei Chen ◽  
Jin-jun Chen ◽  
...  
Keyword(s):  
Liver Injury ◽  
Diagnosis And Treatment ◽  
Drug Induced ◽  
Drug Induced Liver Injury

A Perspective on Improving Evidence and Practice in Cluttering

2009 ◽  
Vol 19 (2) ◽  
pp. 46-51 ◽  
Author(s):  
Kathleen Scaler Scott ◽  
Kenneth O. St. Louis
Keyword(s):  
Research Design ◽  
The State ◽  
Diagnosis And Treatment ◽  
The Past ◽  
Made In

Abstract In the past, the rationale for cluttering to be ignored, not to be taken seriously, and not to be diagnosed could be attributed to several factors stemming from problems in definition and research design. This article reviews these factors and outlines advances being made in the state of evidence on cluttering. Recommendations for ensuring that cluttering research, diagnosis, and treatment remain based in evidence are discussed.

scholarly journals A Preliminary Study on the Effect of Hydrogen Gas on Alleviating Early CCl4-Induced Chronic Liver Injury in Rats

Antioxidants ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1933
Author(s):  
Jianwei Wang ◽  
Quancheng Cheng ◽  
Jinyu Fang ◽  
Huiru Ding ◽  
Huaicun Liu ◽  
...  
Keyword(s):  
Liver Injury ◽  
Liver Tissue ◽  
Uncoupling Protein ◽  
Liver Cells ◽  
Hydrogen Gas ◽  
Chronic Liver ◽  
Control Group ◽  
Protective Mechanism ◽  
Chronic Liver Injury ◽  
Ucp2 Expression

As a small-molecule reductant substance, hydrogen gas has an obvious antioxidant function. It can selectively neutralize hydroxyl radicals (•OH) and peroxynitrite (ONOO•) in cells, reducing oxidative stress damage. The purpose of this study was to investigate the effect of hydrogen gas (3%) on early chronic liver injury (CLI) induced by CCl4 and to preliminarily explore the protective mechanism of hydrogen gas on hepatocytes by observing the expression of uncoupling protein 2 (UCP2) in liver tissue. Here, 32 rats were divided into four groups: the control group, CCl4 group, H2 (hydrogen gas) group, and CCl4 + H2 group. The effect of hydrogen gas on early CLI was observed by serological tests, ELISA, hematoxylin and eosin staining, and oil red O staining. Immunohistochemical staining and Western blotting were used to observe the expression of UCP2 in liver tissues. We found that CCl4 can induce significant steatosis in hepatocytes. When the hydrogen gas was inhaled, hepatocyte steatosis was reduced, and the UCP2 expression level in liver tissue was increased. These results suggest that hydrogen gas might upregulate UCP2 expression levels, reduce the generation of intracellular oxygen free radicals, affect lipid metabolism in liver cells, and play a protective role in liver cells.

Current Options for the Treatment of Pectus Carinatum: When to Brace and When to Operate?

2018 ◽  
Vol 28 (04) ◽  
pp. 347-354 ◽  
Author(s):  
Sherif Emil
Keyword(s):  
Minimally Invasive ◽  
Chest Wall ◽  
Pectus Excavatum ◽  
Surgical Correction ◽  
Diagnosis And Treatment ◽  
Pectus Carinatum ◽  
The Past ◽  
Minimally Invasive Surgical

AbstractPectus carinatum has traditionally been described as a rare chest wall anomaly in comparison to pectus excavatum. However, recent data from chest wall anomaly clinics demonstrate that this deformity is probably much more frequent than once believed. In the past, invasive surgical correction by the Ravitch technique was essentially the only option for treatment of pectus carinatum. Major advances over the past two decades have provided additional options, including noninvasive chest wall bracing and minimally invasive surgical correction. This article will discuss current options for the treatment of pectus carinatum, and some of the factors that should be taken into account when choosing the options available. Diagnosis and treatment of the pectus arcuatum variant will also be described.

scholarly journals Hip Hype: FAI Syndrome, Amara's Law, and the Hype Cycle

2019 ◽  
Vol 23 (03) ◽  
pp. 252-256 ◽  
Author(s):  
Ara Kassarjian
Keyword(s):  
Femoroacetabular Impingement ◽  
Diagnosis And Treatment ◽  
Roller Coaster ◽  
Treatment Pathways ◽  
The Past ◽  
Hype Cycle ◽  
Fai Syndrome

AbstractFemoroacetabular impingement (FAI) has taken us on a roller-coaster ride of innovation, heightened expectations, disillusionment, and confusing diagnostic and treatment pathways. This article reviews and analyzes the phases of FAI diagnosis and treatment over the past 15 years and discusses its parallels to Amara's law and Gartner's hype cycle.

Sign in / Sign up

Export Citation Format

Share Document