Liver injury

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This article is about traumatic liver injuries. For drug-induced liver injury, see Hepatotoxicity.
Liver injury
watercolour painting of a liver with extensive rupturing caused by blunt trauma to the abdomen.
SpecialtyEmergency medicine Edit this on Wikidata

A liver injury, also known as liver laceration, is some form of

trauma sustained to the liver. This can occur through either a blunt force such as a car accident, or a penetrating foreign object such as a knife.[1] Liver injuries constitute 5% of all traumas, making it the most common abdominal injury.[2]
Generally nonoperative management and observation is all that is required for a full recovery.

Cause

Given its

motor vehicle accidents, falls, and sports injuries. Typically these blunt forces dissipate through and around the structure of the liver[3] and causes irreparable damage to the internal microarchitecture of the tissue.[4] With increasing velocity of the impact, the internal damage of the liver tissue also exemplifies[clarification needed] - even though the tissue itself is mechanically and micro-structurally isotropic.[5] A large majority of people who sustain this injury also have another accompanying injury.[1]

Diagnosis

Grade 4 liver laceration
Isoliert_intraparenchymatoese_Leberruptur_24M_-_CT_KM_-_001

Imaging, such as the use of

left lower quadrant of the abdomen. The FAST scan however may not be indicated in those who are obese and those with subcutaneous emphysema.[7] Its speed and sensitivity to injuries resulting in 400mL of free-floating fluid make it a valuable tool in the evaluation of unstable persons. Computed tomography is another diagnostic study which can be performed, but typically is only used in those who are hemodynamically stable.[7] A physical examination may be used but is typically inaccurate in blunt trauma, unlike in penetrating trauma where the trajectory the projectile took can be followed digitally.[8] A diagnostic peritoneal lavage (DPL) may also be utilized but has limited application as it is hard to determine the origin of the bleeding.[9] A diagnostic peritoneal lavage is generally discouraged when FAST is available as it is invasive and non-specific.[7]

Classification

Liver injuries are classified on a

Roman numeral scale with I being the least severe, to V being the most severe, according to the AAST (American Association for the Surgery of Trauma) liver injury scale.[10]

The Liver Injury Scale classification (2018 revision)[1][2][10]
Grade Subcapsular hematoma Laceration Vascular injury
I <10% surface area <1 cm in depth -
II 10–50% surface area 1–3 cm -
III >50% or >10 cm >3 cm Any injury in the presence of a liver vascular injury or active bleeding contained within liver parenchyma
IV 25–75% of a hepatic lobe Active bleeding extending beyond the liver parenchyma into the peritoneum
V >75% of a hepatic lobe Juxtahepatic venous injury to include retrohepatic vena cava and central major hepatic veins

In the case of multiple liver injuries with different grades, the overall grade should be classified by the higher grade of injury. One grade should also be added in case of multiple injuries, up to grade III. [10]

Generally any injury ≥III requires surgery.[3][11]

Management

The initial management of liver trauma generally follows the same procedures for all traumas with a focus on maintaining

hepatic portal vein; with gunshot wounds, the damage is worse.[15]

Surgery

In severe liver injuries (class ≥III), or those with hemodynamic instability, surgery is generally necessary.

hemorrhage.[2][3] Temporary control of the hemorrhage can be accomplished through direct manual pressure to the wound site.[2] In these severe cases it is important to prevent the progression of the trauma triad of death, which often requires the utilization of damage control surgery.[13] New devices are being developed in order to control the bleeding using negative pressure.[16]

The common cause of death while operating is

organ donor in a timely fashion.[18]

History

In the 1880s a severe liver injury would in most cases prove fatal in the first 24 hours after sustaining the injury.[19] Before the 1980s nonoperative management was seldom used in favor of the methods of management suggested by James Hogarth Pringle.[20][21] During World War II the use of early laparotomy was popularized and in conjunction with the use of transfusions, advanced anesthetics, and other new surgical techniques led to decreased mortality.[22]

References

  1. ^
    PMID 20637947
    .
  2. ^
    S2CID 22788477
    .
  3. ^
    PMID 21111696
    .
  4. PMID 29715364
    .
  5. PMID 31151177
    .
  6. ^ Moore 2012, p. 543
  7. ^
    PMID 26309445
    .
  8. ^ Pietzman 2002, p. 255
  9. ^ Moore 2012, p. 542
  10. ^ a b c "Injury Scoring Scale". The American Association for the Surgery of Trauma. 2009-08-27. Retrieved 2023-11-03.
  11. ^
    S2CID 12453253
    .
  12. ^ Moore 2012, p. 541
  13. ^
    PMID 17013521
    .
  14. ISBN 978-1-880696-14-9
    .
  15. ISBN 978-0-340-94764-7
    .
  16. PMID 31889989
    .
  17. S2CID 208270204
    .
  18. S2CID 40857849
    .
  19. ^ Moynihan BB (1906). Abdominal operations. Saunders. p. 563. Retrieved 2012-08-04.
  20. PMID 17862242
    .
  21. PMID 12075841
    .
  22. ^ Moore 2012, p. 539

Bibliography

External links

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