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Liver Trauma
Aka: Liver Trauma, Hepatic Injury, Hepatic Injury Scale, Liver Laceration, Hepatic Laceration, Hepatic Hematoma, Traumatic Liver Hemorrhage, Liver Transection
- See Also
- Abdominal Trauma
- Splenic Injury
- Pediatric Blunt Abdominal Trauma Decision Rule
- Primary Trauma Evaluation
- Secondary Trauma Evaluation
- FAST Exam
- Causes: Liver Trauma
- Penetrating Abdominal Trauma
- Direct Blow
- Liver subcapsular hematoma
- Liver intraparenchymal hematoma
- Rapid Deceleration Injury (with shearing forces)
- Liver Laceration
- Symptoms
- Right Upper Quadrant Abdominal Pain
- Pain radiates to the neck and Shoulders
- Nausea
- Vomiting
- 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)
- 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)
- Labs
- Complete Blood Count
- Comprehensive Metabolic Panel
- ABO Type, Screen and Cross Match
- Coagulation Tests as indicated
- 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)
- Resources
- Radiopedia
- https://radiopaedia.org/articles/aast-liver-injury-scale
- References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21