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Hepatic Rupture

Ruptured Liver


Presentation

  • CASE REPORT: We herein present the first reported case of a pregnant patient with underlying pregnancy-induced hypertension and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome who presented with hepatic rupture following a minor[ncbi.nlm.nih.gov]
  • The clinical triad of toxemia, right upper quadrant pain, and sudden hypotension is the diagnostic hallmark of presentation.[ncbi.nlm.nih.gov]
  • CASE: The patient presented at 33 5/7 weeks of gestation with elevated liver transaminases, thrombocytopenia, and ultrasonographic findings consistent with hepatic rupture.[ncbi.nlm.nih.gov]
  • The patient presented with a sudden mid-epigastric pain and vomiting. Hemoglobin levels decreased a few hours later and a computed tomography scan was performed which revealed a rupture of the right liver capsule and hemoperitoneum.[ncbi.nlm.nih.gov]
  • Life-threatening spontaneous liver rupture due to systemic amyloidosis might only successfully be cured by high urgency liver transplantation as presented in the literature.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Hepatic rupture in HELLP syndrome should be considered a differential diagnosis in pregnant patients with sudden onset of abdominal pain or hypotension.[ncbi.nlm.nih.gov]
  • CASE: A 27-year-old women (G1P0), pregnant with monochorionic-monoamniotic twins, developed extensive abdominal pain while she was electively admitted at 32 weeks for fetal pulmonary maturation.[ncbi.nlm.nih.gov]
  • The most frequent signs and symptoms of hepatic rupture were the sudden onset of abdominal pain, acute anemia, and hypotension. Laboratory findings included low platelet count and increased hepatic enzymes. Surgery was performed in 9 cases.[ncbi.nlm.nih.gov]
  • We report a case of HAS complicated by spontaneous hepatic rupture in a 68-year-old female farmer who presented with acute onset of abdominal pain and shock.[ncbi.nlm.nih.gov]
  • The patient was a 39-year-old male who presented with upper abdominal pain over 3 months. Computed tomography showed multiple tumors in both hepatic lobes, while lower gastrointestinal endoscopy revealed a tumor in the transverse colon.[ncbi.nlm.nih.gov]
Acute Abdomen
  • Abdomen in Pregnancy will serve practitioners as a quick-reference guide to those who encounter pregnant women in pain.[books.google.de]
  • Ruptured giant liver cyst: a rare cause of acute abdomen in a haemodialysis patient with autosomal dominant polycystic kidney disease. Neth J Med. 2002;60:363–5.[surgicalcasereports.springeropen.com]
  • The diagnosis of liver rupture must be included in the differential diagnosis of acute abdomen both antepartum and post-partum, especially in patients with severe preeclampsia.[saudijgastro.com]
Abdominal Distension
  • The SLH may present as right upper quadrant abdominal pain or shoulder pain, abdominal distension, nausea or vomiting.[casereports.in]
  • distension Unknown Unknown Left lateral segmentectomy, resection of the walls of the cysts 10 months, no symptoms Conclusions PCLD is a different disease from ADPKD, tends to have greater and larger cysts and thus cause pressure symptoms more often than[surgicalcasereports.springeropen.com]
Hypotension
  • The patient had hypotension, falling hematocrit level, hepatomegaly, and evidence of progressive hepatocellular dysfunction. Hepatic dysfunction is not uncommon in rheumatoid arthritis, but is usually asymptomatic.[ncbi.nlm.nih.gov]
  • In the setting of primary amyloidosis, the early use of CT scanning for undiagnosed ascites, hypotension, or rapid organ enlargement may lead to early diagnosis and potential surgical correction.[ncbi.nlm.nih.gov]
  • The clinical triad of toxemia, right upper quadrant pain, and sudden hypotension is the diagnostic hallmark of presentation.[ncbi.nlm.nih.gov]
  • The most frequent signs and symptoms of hepatic rupture were the sudden onset of abdominal pain, acute anemia, and hypotension. Laboratory findings included low platelet count and increased hepatic enzymes. Surgery was performed in 9 cases.[ncbi.nlm.nih.gov]
  • Hepatic rupture in HELLP syndrome should be considered a differential diagnosis in pregnant patients with sudden onset of abdominal pain or hypotension.[ncbi.nlm.nih.gov]

Workup

  • The workup at that time was consistent with an intra-abdominal abscess and a reactive pleural effusion, which are the known complications of liver embolization.[mdmag.com]
  • If possible, a premortem peripheral blood smear should be examined and the clinical workup reviewed.[captodayonline.com]
  • The underlying disorder can have a significant effect on morbidity and mortality in both mother and fetus, and a diagnostic workup should be initiated promptly.[clevelandclinicmeded.com]

Treatment

  • Controversiality exists with regard to the treatment modality.[ncbi.nlm.nih.gov]
  • Maternal and fetal mortality rates are still high despite advances in diagnosis and treatment. We aimed to present our experience at two referral centers for hepatic disease and to compare it with cases from the literature.[ncbi.nlm.nih.gov]
  • Adequate treatment requires a multidisciplinary approach. Copyright (c) 2010 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
  • Several different surgical treatments have been described, depending on the severity of the rupture. Liver transplantation has become the mainstay for patients with end-stage liver disease.[ncbi.nlm.nih.gov]
  • RATIONALE: Currently, percutaneous catheter drainage (PCD) is regarded as the first-line treatment modality of pyogenic liver abscess. Severe complications associated with PCD were uncommon.[ncbi.nlm.nih.gov]

Prognosis

  • The cornerstone of prognosis is early diagnosis. Hepatic rupture in HELLP syndrome should be considered a differential diagnosis in pregnant patients with sudden onset of abdominal pain or hypotension.[ncbi.nlm.nih.gov]
  • In serious hepatic lesions, transplantation has been used, although these are exceptional situations. 6 Prognosis depends on the etiology, severity of the hemorrhage and the speed and efficacy of treatment.[elsevier.es]
  • Prognosis Malignant transformation is rare and the long-term prognosis is good. The documents contained in this web site are presented for information purposes only.[orpha.net]
  • In addition to pain and hemorrhagic shock, there is also a risk of peritoneal seeding of cancer cells, which worsen the prognosis. The diagnosis can be confirmed by the presence of hemoperitoneum on abdominal paracentesis.[hrjournal.net]
  • Though looking alarming, awareness of this entity and visualization with computed tomography can help to explain the prognosis to the patients Competing interests The authors declare no competing interests.[panafrican-med-journal.com]

Etiology

  • Most series to date reported the incidence and characteristics of a single etiology. METHODS: Data were collected for all patients admitted with spontaneous hepatic rupture from 1995 to 2007. RESULTS: Ten patients met the study criteria.[ncbi.nlm.nih.gov]
  • The radiological and pathological studies ruled out other etiologies that would have explained the rupture.[elsevier.es]
  • Most series to date reported the incidence and characteristics of a single etiology. Data were collected for all patients admitted with spontaneous hepatic rupture from 1995 to 2007. Ten patients met the study criteria.[journals.lww.com]
  • Although several possibilities have been described, the exact etiology still remains unknown.[wjgnet.com]
  • Etiology In most cases, adenomas develop for unclear reasons in an otherwise healthy liver.[orpha.net]

Epidemiology

  • Summary Epidemiology Annual incidence is estimated at one case per million. Clinical description Mean age at diagnosis is 34 years (ranging from 15 to 64 years). HA rarely occurs in children.[orpha.net]
  • EPIDEMIOLOGY According to the case report and literature review by Vokaer et al[ 8 ], since 1898 when Van Haefen described the first case of spontaneous rupture of a liver hemangioma, only 33 cases of ruptured hemangioma in adults have been reported in[wjgnet.com]
  • Pathophysiology, epidemiology, classification and treatment options for polycystic liver diseases. World J Gastroenterol. 2013;19:5775–86.[surgicalcasereports.springeropen.com]
Sex distribution
Age distribution

Pathophysiology

  • Underlying pathophysiology of preeclampsia? Cure? Vasospasm and "leaky vessels" which cause local hypoxemia. Hypoxemia leads to hemolysis, necrosis, and end organ damage End of pregnancy (Usually delivery) Complications of preeclampsia? 1.[brainscape.com]
  • The pathophysiology of this condition is complex and poorly understood. The origin of pre-eclampsia/HELLP can be attributed to defective trophoblastic invasion.[wjes.biomedcentral.com]
  • Pathophysiology, epidemiology, classification and treatment options for polycystic liver diseases. World J Gastroenterol. 2013;19:5775–86.[surgicalcasereports.springeropen.com]
  • There are no clinical markers that predict the course of a pregnancy and the pathophysiologic mechanisms are not always understood, but knowledge and management of the preconception liver disease and efficacious pre-pregnancy and prenatal care are essential[clevelandclinicmeded.com]

Prevention

  • Early initiation of anticoagulation is both safe and effective in preventing APAS complications. Aspirin should be initiated to prevent future thrombosis and pregnancy loss.[lupus.bmj.com]
  • Sometimes there is bleeding at the staple line Continued Can Bleeding Varices Be Prevented? Treating the underlying cause of bleeding varices can help prevent their return. Earlier treatment of liver disease may prevent them from developing.[webmd.com]
  • What Can I Do to Prevent HELLP Syndrome? Unfortunately, there's currently no way to prevent this illness.[preeclampsia.org]
  • Many of these women are sexually active and do not take effective measures to prevent pregnancy.[clevelandclinicmeded.com]
  • Coagulopathy prevented haemostasis by electro-cautery or using topical agents and thus haemostasis was secured by packing the liver with gauze swabs placed above and around the liver in a routine manner.[wjes.biomedcentral.com]

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