Liver injury

Background

• Occurs in 5% of all traumas
  • Most common abdominal injury

Clinical Features

• RUQ pain

Differential Diagnosis

Abdominal Trauma

• Abdominal compartment syndrome
• Diaphragmatic trauma
• Duodenal hematoma
• Genitourinary trauma
• Liver trauma
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• Retroperitoneal hemorrhage
• Renal trauma
• Splenic trauma
• Trauma in pregnancy
• Ureter trauma

Diagnosis

ATLS Blunt Abdominal Trauma Algorithm

• Unstable
  • FAST to search for free fluid (vs. DPL if unavailable)
    • Positive: Exploratory laparotomy
    • Negative: CT scan
• Stable
  • CT scan
    • Exploratory laparotomy, angiographic embolization, conservative management as indicated

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

See Also

• Abdominal Trauma
• Trauma in Pregnancy