Liver injury: Difference between revisions
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==Background== | ==Background== | ||
[[File:Sobo 1906 389.png|thumb|Inferior view of the liver with surface showing lobes and impressions.]] | |||
[[File:Liver vascular anatomy.png|thumb|Liver vascular anatomy.]] | |||
*Occurs in 5% of all traumas | *Occurs in 5% of all traumas | ||
**Most common abdominal injury | **Most common abdominal injury | ||
==Clinical Features== | ==Clinical Features== | ||
*[[RUQ pain]] | *[[RUQ pain]] | ||
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==Evaluation== | ==Evaluation== | ||
{{ATLS | {{ATLS abd trauma diagnosis algorithm}} | ||
===American Association for the Surgery of Trauma Grading System=== | ===American Association for the Surgery of Trauma Grading System=== | ||
[[File:Grade4LiverLacMark.png|thumb|Grade 4 liver laceration (arrow).]] | |||
* | {| class="wikitable" | ||
* | |+ '''The Liver Injury Scale classification''' | ||
|- | |||
* | ! Grade^ !! Hematoma !! Laceration | ||
* | |- | ||
* | | I || | ||
*Subcapsular: <10% surface area | |||
* | || | ||
* | *Capsular tear: <1 cm in depth | ||
* | |- | ||
| II | |||
* | || | ||
* | *Subcapsular: 10-50% surface area | ||
*Intraparenchymal: <10 cm diameter | |||
** | || | ||
* | *Capsular tear: 1-3 cm depth, <10 cm length1–3 cm | ||
|- | |||
* | | III | ||
|| | |||
;Advance one grade for multiple injuries up to grade III | *Subcapsular: >50% surface area, or ruptured with active bleeding | ||
*Intraparenchymal: >10 cm diameter | |||
|| | |||
*Capsular tear: >3 cm depth | |||
|- | |||
| IV | |||
|| | |||
*Ruptured intraparenchymal with active bleeding | |||
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*Parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments (within one lobe) | |||
|- | |||
| V | |||
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*Ruptured intraparenchymal with active bleeding | |||
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*Parenchymal disruption involving >75% of hepatic lobe or involves >3 Couinaud segments (within one lobe) | |||
*Juxtahepatic venous injuries (inferior vena cava, major hepatic vein) | |||
|- | |||
| VI | |||
|| | |||
|| | |||
*Hepatic avulsion | |||
|} | |||
;^Advance one grade for multiple injuries up to grade III | |||
==Management== | ==Management== | ||
Latest revision as of 23:04, 13 November 2024
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^ | Hematoma | Laceration |
|---|---|---|
| I |
|
|
| II |
|
|
| III |
|
|
| IV |
|
|
| V |
|
|
| VI |
|
- ^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