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Liver trauma
From WikEM
(Redirected from Liver injury)
Contents
Background
- Occurs in 5% of all traumas
- Most common abdominal injury
Clinical Features
Differential Diagnosis
Abdominal Trauma
- Liver trauma
- Splenic trauma
- Pelvic fractures
- Genitourinary trauma
- Retroperitoneal hemorrhage
- Renal trauma
- Ureter trauma
- Abdominal compartment syndrome
- Trauma in pregnancy
Evaluation
Template:ATLS abdominal trauma diagnosis algorithm
American Association for the Surgery of Trauma Grading System
- grade I
- Hematoma: subcapsular, <10% surface area
- laceration: capsular tear, <1 cm depth
- grade II
- hematoma: subcapsular, 10-50% surface area
- hematoma: intraparenchymal <10 cm diameter
- laceration: capsular tear, 1-3 cm depth, <10 cm length
- grade III
- hematoma: subcapsular, >50% surface area, or ruptured with active bleeding
- hematoma: intraparenchymal >10 cm diameter
- laceration: capsular tear, >3 cm depth
- grade IV
- hematoma: ruptured intraparenchymal with active bleeding
- laceration: parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments (within one lobe)
- grade V
- laceration: parenchymal disruption involving >75% of hepatic lobe or involves >3 Couinaud segments (within one lobe)
- vascular: juxtahepatic venous injuries (inferior vena cava, major hepatic vein)
- grade VI
- vascular: 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
