Liver injury: Difference between revisions

m (Rossdonaldson1 moved page Liver Injury to Liver trauma)
m (Rossdonaldson1 moved page Liver trauma to Liver injury)
 
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==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}}


==Workup==
==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 pts who are hemodynamically stable  
*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.  
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==Disposition==
==Disposition==
*Typically admission via OR, IR, or floor/ICU for conservative management


==See Also==
==See Also==
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*[[Trauma in Pregnancy]]
*[[Trauma in Pregnancy]]


==Sources==
==References==
Tintinalli's
 
<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

Evaluation

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

American Association for the Surgery of Trauma Grading System

Grade 4 liver laceration (arrow).
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

  • 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

References