Liver injury: Difference between revisions
m (Rossdonaldson1 moved page Liver Injury to Liver trauma) |
m (Rossdonaldson1 moved page Liver trauma to Liver injury) |
||
(32 intermediate revisions by 4 users not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Occurs in 5% of all traumas | |||
**Most common abdominal injury | |||
==Clinical Features== | ==Clinical Features== | ||
*[[RUQ pain]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Abdominal trauma DDX}} | {{Abdominal trauma DDX}} | ||
== | ==Evaluation== | ||
{{ATLS abd trauma diagnosis algorithm}} | |||
===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 | |||
|| | |||
*Subcapsular: >50% surface area, or ruptured with active bleeding | |||
*Intraparenchymal: >10 cm diameter | |||
|| | |||
*Capsular tear: >3 cm depth | |||
|- | |||
| IV | |||
|| | |||
*Ruptured intraparenchymal with active bleeding | |||
|| | |||
*Parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments (within one lobe) | |||
|- | |||
| V | |||
|| | |||
*Ruptured intraparenchymal with active bleeding | |||
|| | |||
*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== | ||
*Nonoperative management is successful in >90% of | *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 | *Low-grade injuries (grades I–III) can almost always be managed without surgery | ||
**Higher-grade injuries commonly fail nonoperative therapy. | **Higher-grade injuries commonly fail nonoperative therapy. | ||
Line 17: | Line 66: | ||
==Disposition== | ==Disposition== | ||
*Typically admission via OR, IR, or floor/ICU for conservative management | |||
==See Also== | ==See Also== | ||
Line 22: | Line 72: | ||
*[[Trauma in Pregnancy]] | *[[Trauma in Pregnancy]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Trauma]] | [[Category:Trauma]] |
Latest revision as of 21:20, 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^ | 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