Emergency procedure for internal bleeding after liver biopsy

Liver is the largest substantive organ in the abdominal cavity, responsible for the important physiological functions of the human body. Liver cells have poor tolerance to hypoxia, so there are hepatic arteries and portal veins to provide rich blood supply, and bile ducts and blood vessels to transport bile. It is located deep in the right upper abdomen and is protected by the lower chest wall and diaphragm. However, due to the large size and brittle texture of the liver, once subjected to violence, it is easy to be damaged, the occurrence of intra-abdominal bleeding or bile leakage, causing hemorrhagic shock and/or biliary peritonitis, serious consequences, must be diagnosed in time and correct treatment.

Open injury, according to the location of the wound, the depth and direction of the wound path, the diagnosis of liver injury is not difficult. The diagnosis of closed true hepatic laceration with obvious intraperitoneal bleeding and peritoneal irritation is not difficult. It may be difficult to diagnose liver laceration only when symptoms and signs are not obvious in subcapsular liver laceration, subcapsular hematoma and central laceration. It is necessary to make a comprehensive analysis based on the injury condition and clinical manifestations, and closely observe the changes of vital signs and abdominal signs. The following tests may be helpful in diagnosis:

(1) Diagnostic abdominal puncture needle This method is of great value for the diagnosis of intraperitoneal organ rupture, especially for substantial organ laceration. Generally do not clot blood can be considered to have visceral damage. However, there may be false negative results when the amount of blood loss is small, so a negative puncture cannot exclude visceral injury. If necessary, perform multiple piercings in different places and at different times, or perform diagnostic lavage in abdominal cavity to aid diagnosis.

(2) Periodic measurement of red blood cells, hemoglobin and hematocrit to observe their dynamic changes, if there is progressive anemia, indicating internal bleeding.

(3) B-type ultrasound examination method can not only find intra-abdominal hematoma, but also help the diagnosis of subcapsular hematoma and intrahepatic hematoma, which is commonly used in clinic.

(4) X-ray examination, if there is subcapsular hematoma, cavity organ injury.

(5) Liver radionuclide scan can be used to diagnose the closed injury that is not yet clear and suspected to have subcapsular or intrahepatic hematoma. If the injury is not very urgent, isotope liver scan can be performed when the patient condition permits. There are radioactive defects in the liver of patients with hematoma.

(6) Selective hepatic angiography can be used for some closed injuries that are really difficult to diagnose, such as suspected intrahepatic hematoma and not very urgent injury. The formation of intrahepatic arterial branch aneurysms or contrast extravasation and other diagnostic signs were observed. But this is an invasive examination, the operation is complicated, can only be performed under certain conditions, can not be used as a routine examination.