Liver injury

Background

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

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

Workup

• Radiography to evaluate severity, determine best imagery
  • CT
  • MRI
  • X-ray
• FAST Ultrasound
• DPL
  • >10mL of blood = positive
• Wound exploration if applicable

Management

• Nonoperative management is successful in >90% of pts 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

See Also

• Abdominal Trauma
• Trauma in Pregnancy

Sources

• Tintinalli's
• Rosen's