Liver Trauma

Aka: Liver Trauma, Hepatic Injury, Hepatic Injury Scale, Liver Laceration, Hepatic Laceration, Hepatic Hematoma, Traumatic Liver Hemorrhage, Liver Transection

II. Causes: Liver Trauma

  1. Penetrating Abdominal Trauma
  2. Direct Blow
    1. Liver subcapsular hematoma
    2. Liver intraparenchymal hematoma
  3. Rapid Deceleration Injury (with shearing forces)
    1. Liver Laceration

III. Symptoms

  1. Right Upper Quadrant Abdominal Pain
  2. Pain radiates to the neck and Shoulders
  3. Nausea
  4. Vomiting

IV. Imaging

  1. FAST Scan or Focused bedside RUQ Ultrasound
    1. Test Sensitivity: 85% for intraabdominal injury
    2. Test Specificity: 99%
  2. CT Abdomen and Pelvis with IV contrast
    1. Indicated in stable patients
    2. Unstable patients should undergo emergent exploratory laparotomy (see below)

V. Grading: Hepatic Injury Scale

  1. Grade 1
    1. Hematoma: Subscapular Hematoma >10% surface area
    2. Laceration: Capsular Tear parenchymal depth <1 cm
  2. Grade 2
    1. Hematoma: Subcapsular hematoma 10-50% surface area, or Intraparenchymal <10 cm diameter
    2. Laceration: Capsular Tear parenchymal depth 1-3 cm, length <10 cm
  3. Grade 3
    1. Hematoma: Subcapsular hematoma >50% surface area, or ruptured hematoma, intraparenchymal >10 cm
    2. Laceration: Capsular Tear parenchymal depth >3 cm
  4. Grade 4
    1. Laceration: Hepatic lobe parenchymal disruption 25-75% or 1-3 Couinaud segments in single lobe
    2. Vascular: Active bleeding from the liver parenchyma into the peritoneum
  5. Grade 5
    1. Laceration: Hepatic lobe parenchymal disruption >75%
    2. Vascular: Juxtahepatic major venous injury (vena cava, major central hepatic veins)

VI. Labs

  1. Complete Blood Count
  2. Comprehensive Metabolic Panel
  3. ABO Type, Screen and Cross Match
  4. Coagulation Tests as indicated

VII. Management

  1. See ABC Management
  2. See Hemorrhagic Shock
  3. Liver injuries spontaneously stop bleeding in 50-80% of cases
  4. Unstable patients should undergo emergent exploratory laparotomy (see below)
    1. Control Bleeding
    2. Repair or resect damaged liver tissue
  5. Stable patients
    1. Observation
    2. Follow serial RUQ Ultrasound (preferred over serial CT Abdomen)

VIII. Resources

  1. Radiopedia
    1. https://radiopaedia.org/articles/aast-liver-injury-scale

IX. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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Related Studies

Ontology: Liver hematoma (C0347630)

Concepts Disease or Syndrome (T047)
SnomedCT 262796008
Italian Ematoma del fegato
Dutch hepatisch hematoom, hematoom; lever, lever; hematoom, leverhematoom
French Hématome hépatique, Hématome du foie
Japanese 肝血腫, ｶﾝｹｯｼｭ
English hepatic hematoma (diagnosis), hepatic hematoma, Hepatic haematoma, Hepatic hematoma, hematoma liver, hematomas liver, liver hematoma, Liver haematoma, Liver hematoma, Liver hematoma (disorder), hematoma; liver, liver; hematoma
Czech Hematom jater
Hungarian Haematoma hepatis
Spanish hematoma de hígado (trastorno), hematoma de hígado, Hematoma hepático
Portuguese Hematoma hepático
German Haematom der Leber
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Laceration of liver (C0347633)

Concepts Injury or Poisoning (T037)
SnomedCT 42663008, 262802005
English Liver Laceration, laceration of liver (diagnosis), laceration of liver, Liver laceration, hepatic laceration, laceration liver, liver laceration, lacerations liver, LIVER LACERATION(S), LACERATION(S), LIVER, Laceration of liver, Hepatic laceration, Laceration of liver (disorder), Hepatic laceration, NOS, Laceration of liver, NOS, Laceration of liver (disorder) [Ambiguous]
Spanish Laceración hepática, laceración del hígado (trastorno), laceración del hígado, laceración de hígado (trastorno), laceración de hígado, laceración del hígado (concepto no activo), laceración hepática
Dutch leverlaceratie
German Lazeration der Leber
Japanese ｶﾝﾚｯｼｮｳ, 肝裂傷
Czech Lacerace ledvin
Portuguese Laceração do fígado
Italian Lacerazione epatica
French Lacération du foie
Hungarian Máj laceratio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Transection of liver (C0434026)

Concepts Injury or Poisoning (T037)
SnomedCT 262803000
English transection of liver (diagnosis), Transection of liver, Transection of liver (disorder)
Spanish sección del hígado (trastorno), sección del hígado
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Traumatic hemorrhage of liver (C0520749)

Concepts Injury or Poisoning (T037)
SnomedCT 78171005
English traumatic hepatic hemorrhage (diagnosis), Traumatic haemorrhage of liver, Traumatic hemorrhage of liver, Traumatic hepatic haemorrhage, Traumatic hepatic hemorrhage, Traumatic hemorrhage of liver (disorder)
Spanish hemorragia hepática traumática, hemorragia traumática del hígado (trastorno), hemorragia traumática del hígado
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Liver

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