Liver Trauma

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

1. See Also
   1. Abdominal Trauma
   2. Splenic Injury
   3. Pediatric Blunt Abdominal Trauma Decision Rule
   4. Primary Trauma Evaluation
   5. Secondary Trauma Evaluation
   6. FAST Exam
2. 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
3. Symptoms
   1. Right Upper Quadrant Abdominal Pain
   2. Pain radiates to the neck and Shoulders
   3. Nausea
   4. Vomiting
4. 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)
5. 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)
6. Labs
   1. Complete Blood Count
   2. Comprehensive Metabolic Panel
   3. ABO Type, Screen and Cross Match
   4. Coagulation Tests as indicated
7. 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)
8. Resources
   1. Radiopedia
      1. https://radiopaedia.org/articles/aast-liver-injury-scale
9. References
   1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21