II. Causes: Liver Trauma
- Penetrating Abdominal Trauma
- Direct Blow
- Rapid Deceleration Injury (with shearing forces)
- Liver Laceration
III. Symptoms
- Right Upper Quadrant Abdominal Pain
- Pain radiates to the neck and Shoulders
- Nausea
- Vomiting
IV. Imaging
- FAST Scan or Focused bedside RUQ Ultrasound
- Test Sensitivity: 85% for intraabdominal injury
- Test Specificity: 99%
-
CT Abdomen and Pelvis with IV contrast
- Indicated in stable patients
- Unstable Patients should undergo emergent exploratory laparotomy (see below)
V. Grading: Hepatic Injury Scale
- Grade 1
- Hematoma: Subscapular Hematoma >10% surface area
- Laceration: Capsular Tear parenchymal depth <1 cm
- Grade 2
- Hematoma: Subcapsular Hematoma 10-50% surface area, or Intraparenchymal <10 cm diameter
- Laceration: Capsular Tear parenchymal depth 1-3 cm, length <10 cm
- Grade 3
- Hematoma: Subcapsular Hematoma >50% surface area, or ruptured Hematoma, intraparenchymal >10 cm
- Laceration: Capsular Tear parenchymal depth >3 cm
- Grade 4
- Laceration: Hepatic lobe parenchymal disruption 25-75% or 1-3 Couinaud segments in single lobe
- Vascular: Active bleeding from the liver parenchyma into the peritoneum
- Grade 5
- Laceration: Hepatic lobe parenchymal disruption >75%
- Vascular: Juxtahepatic major venous injury (vena cava, major central hepatic veins)
VI. Labs
- Complete Blood Count
- Comprehensive Metabolic Panel
- ABO Type, Screen and Cross Match
- Coagulation Tests as indicated
VII. Management
- See ABC Management
- See Hemorrhagic Shock
- Liver injuries spontaneously stop bleeding in 50-80% of cases
-
Unstable Patients should undergo emergent exploratory laparotomy (see below)
- Control Bleeding
- Repair or resect damaged liver tissue
- Stable patients
- Observation
- Follow serial RUQ Ultrasound (preferred over serial CT Abdomen)
VIII. Resources
IX. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
Images: Related links to external sites (from Bing)
Related Studies
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 |
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 |
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 |
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 |