Unit 6- Liver Trauma and Transplant ~ Elie

Liver trauma can be either:

Blunt or penetrating

Where can the location of liver trauma be?

• Intrahepatic

• Subcapsular with intact capsule

• Rupture of capsule

What are the sonographic features of liver truama?

Depends on age and location of hematoma

In liver trauma, the intraperitoneal fluid should be assessed where?

Along the flanks and into pelvis

What are lacerations and contusions echogenicity?

Heterogeneous or hyperechoic

What do hematomas and lacerations look like sonographically?

• Initially: Hypoechoic with low-level echoes or echogenic as blood begins to coagulate

• Over time: Becomes more anechoic

Liver Transplant will occur when?

In patients with end stage liver disease

In children with end-stage liver disease, what do you evaluate?

Biliary atresia - both kidneys and spleen

In adults with end stage liver disease, what do they most likely have?

Cirrhosis due to chronic hepatitis C followed by alcoholic liver disease

HCC

Early stage

What is the criteria for a liver transplant?

• No lesion > 5cm

• No more than 3 lesions > 3cm

What are the contraindications for a liver transplant?

• Compensated cirrhosis with complications

• Extrahepatic malignancy

• Cholangiocarcinoma

• Active untreated sepsis

• Advanced cardiopulmonary disease

• Active alcoholism or substance abuse

• Anatomic abnormality precluding the surgical procedure

• PV Thrombosis is predictor of higher risk

What are the different types of liver transplant options?

• Surgical Technique

• Cadaveric Liver Donation

• Living Donor Transplants

• Pediatric Patients

What are the pre and post-op evaluations for a liver transplant?

• Doppler Vascular structures: PV, HA, HV, IVC & (collaterals)

• Liver parenchymal pattern

• Pathology

• Biliary system - dilation

What are some possible post-op complications of a liver transplant?

• HA Thrombosis (no flow)

• Anastomotic stenosis

• Portal Vein Thrombosis

• Fatal Complication- Hepatic Necrosis from thrombosis

• Gangrene – produces air or gas in hepatic parenchyma

HA Liver transplant doppler normals:

• Hepatopetal

• Low-resistant flow

• PSV <200 cm/s

• RI 0.5 to 0.7

HV and IVC Liver transplant doppler normals:

• Hepatofugal

• Phasic bidirectional flow, representing phasicity & pulsatility

PV Liver transplant doppler normals:

• Hepatopetal

• Continuous flow with minimal phasicity

What is required to do immediately post-op of a liver transplant?

•Use sterile gel & probe cover

•Surgeon may be present

•Ensure adequate arterial & venous flow

•Look for hemorrhage

•Common to see postop fluid collections

•Postop edema can create elevated velocities in HAs or venous system

•Urgent Findings:

-HA, PV, HV, IVC Thrombus or occlusion

What must be evaluated following a liver transplant?

Lab work: LFTs & Coagulation

When do you perform follow-up ultrasound exams after a liver transplant?

• Day 0, 1 & 7

• Yearly

• Anytime if concerned for complications

What is the follow-up ultrasound-guided biopsy after a liver transplant?

• Day 7

• Possibly yearly

Ensure no disease recurrence

R/O rejection

What are some possible liver transplant complications?

• Rejection

A high RI of HA may indicate rejection or hepatic venous congestion

• Infection; Abscess (Infarct)

• Thrombosis, stenosis or leak

HA

PV, HV, IVC

What are some possible liver transplant complications for vascular?

Thrombosis

• HA

• PV

• IVC

  Stricture

  Anastomotic pseudoaneurysm

Liver transplant Complications (3)

Infarction & Necrosis

Biliary stricture or leak

Fluid collections

• Hematoma

• Seroma

• Lymphocele

• Biloma

• Loculated ascites

• Abscess; Infarct

Liver transplant Complications (5)

HCC & Mets

Hepatitis Recurrence

PV Gas & Bowel Ischemia

Posttransplant Lymphoproliferative Disorder (hyperplasia of tissue to lymphoma)

Common Benign Findings:

• Cysts

• Hemangiomas

• Pneumobilia

• Fatty Liver & Focal Sparing