[Long-term liver damage due to trauma].
Severe trauma has a major influence on the visceral organs, especially on the liver. Splanchnic hypotension leads to necrosis of the bile duct cells as well as to damage to hepatocytes. Furthermore, the liver is a very immunologically active organ so that damage to the liver can increase the amount of proinflammatory cytokines. The major complication of post-traumatic damage to the liver is secondary sclerosing cholangitis (SCC) a highly progressive disease for which there is no sufficient therapy except liver transplantation. Therefore it is very important to put all efforts into avoiding posttraumatic liver damage from the very beginning. A sophisticated resuscitation therapy is the most important aspect. Direct peritoneal volume resuscitation is a promising possibility to improve perfusion of the visceral organs. Other possibilities are substitution with 17beta-estradiol as a strongly vasoactive hormone with a positive effect on liver perfusion and interleukin-10 as modulator of the immune reaction caused by the liver.
Winter
A
A
Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie, Chirurgische Klinik, Bundeswehrkrankenhaus Berlin, Scharnhorststrasse 13, 10115 Berlin. axelhartwigwinter@bundeswehr.org
Oestmann
J W
JW
Lenz
S
S
D000007:Abdominal Injuries / Q000150:complications / Q000209:etiology / Q000473:pathology*; D001652:Bile Ducts / Q000473:pathology; D015209:Cholangitis, Sclerosing / Q000209:etiology; D016207:Cytokines / Q000502:physiology; D004958:Estradiol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D016753:Interleukin-10 / Q000627:therapeutic use; D007565:Jaundice / Q000209:etiology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008107:Liver Diseases / Q000150:complications / Q000209:etiology / Q000473:pathology*; D008297:Male; D010529:Peritoneal Cavity; D012151:Resuscitation / Q000379:methods; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000473:pathology*
D016207:Cytokines; D016753:Interleukin-10; D004958:Estradiol