Liver injury
Revision as of 21:20, 13 June 2019 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Liver trauma to Liver injury)
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