Liver injury: Difference between revisions
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===American Association for the Surgery of Trauma Grading System=== | ===American Association for the Surgery of Trauma Grading System=== | ||
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|+ '''The Liver Injury Scale classification'''<ref name="piper"/><ref name="clay"/> | |||
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! Grade !! Subcapsular hematoma !! Laceration | |||
|- | |||
| I || <10% surface area || < 1 cm in depth | |||
|- | |||
| II || 10–50% surface area || 1–3 cm | |||
|- | |||
| III || >50% or >10 cm || >3 cm | |||
|- | |||
| IV || 25–75% of a hepatic lobe || | |||
|- | |||
| V || >75% of a hepatic lobe || | |||
|- | |||
| VI || Hepatic avulsion || | |||
|} | |||
Liver injuries are classified on a [[Roman numeral]] scale with I being the least severe, to VI being the most severe. Generally any injury ≥III requires surgery.<ref name="blunt"/><ref name="polish"/> | |||
[[File:Grade4LiverLacMark.png|thumb|Grade 4 liver laceration (arrow).]] | [[File:Grade4LiverLacMark.png|thumb|Grade 4 liver laceration (arrow).]] | ||
*grade I | *grade I | ||
Revision as of 18:27, 13 June 2019
Background
- Occurs in 5% of all traumas
- Most common abdominal injury
Clinical Features
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
ATLS Blunt Abdominal Trauma Algorithm
- Unstable
- Stable
- CT scan
- Exploratory laparotomy, angiographic embolization, conservative management as indicated
- CT scan
American Association for the Surgery of Trauma Grading System
| Grade | Subcapsular hematoma | Laceration |
|---|---|---|
| I | <10% surface area | < 1 cm in depth |
| II | 10–50% surface area | 1–3 cm |
| III | >50% or >10 cm | >3 cm |
| IV | 25–75% of a hepatic lobe | |
| V | >75% of a hepatic lobe | |
| VI | Hepatic avulsion |
Liver injuries are classified on a Roman numeral scale with I being the least severe, to VI being the most severe. Generally any injury ≥III requires surgery.[3][4]
- grade I
- Hematoma: subcapsular, <10% surface area
- laceration: capsular tear, <1 cm depth
- grade II
- hematoma: subcapsular, 10-50% surface area
- hematoma: intraparenchymal <10 cm diameter
- laceration: capsular tear, 1-3 cm depth, <10 cm length
- grade III
- hematoma: subcapsular, >50% surface area, or ruptured with active bleeding
- hematoma: intraparenchymal >10 cm diameter
- laceration: capsular tear, >3 cm depth
- grade IV
- hematoma: ruptured intraparenchymal with active bleeding
- laceration: parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments (within one lobe)
- grade V
- laceration: parenchymal disruption involving >75% of hepatic lobe or involves >3 Couinaud segments (within one lobe)
- vascular: juxtahepatic venous injuries (inferior vena cava, major hepatic vein)
- grade VI
- vascular: hepatic avulsion
- Advance one grade for multiple injuries up to grade III
Management
- Nonoperative management is successful in >90% of patients who are hemodynamically stable
- Low-grade injuries (grades I–III) can almost always be managed without surgery
- Higher-grade injuries commonly fail nonoperative therapy.
- Consider angiographic embolization if:
- Large amount of hemoperitoneum
- Vascular injury (contrast blush) on CT
Disposition
- Typically admission via OR, IR, or floor/ICU for conservative management