The largest gland of the human body, the incidence of liver lacerations is quite high in abdominal trauma. This HealthHearty write-up provides information on the contributing factors, symptoms, and treatment of a lacerated liver.
Located in the upper right section of the abdomen, the liver performs several functions that are essential for the healthy functioning of the human body. It secretes bile, which is a digestive fluid that is essential for the digestion of fats. It filters blood, and plays a role in the production of certain proteins and blood clotting factors. It also helps regulate blood glucose levels. While liver function can get adversely affected due to certain medical conditions, blunt or penetrating trauma to the liver can also cause damage to the liver. Penetrating trauma to the liver can cause the development of a tear in the soft tissue of the liver. Medical help must be immediately sought in the event of accidents involving trauma to the abdomen. Coming second to spleen, the liver is the second most frequently wounded abdominal organ. The high incidence of liver injuries could be attributed to its large size and location. Diagnostic tests should be conducted to identify the location and extent of damage.
The term ‘blunt trauma’ refers to an injury caused by the impact of a blunt object or surface. On the other hand, ‘penetrating trauma’ refers to an injury caused by a sharp object such a knife or a bullet. So, a blow to the upper abdominal region is an example of blunt force trauma that can cause a tear, cut, or bruise in the liver. The liver could get lacerated due to penetrating trauma by a sharp instrument. If the blood vessels get ruptured, it might give rise to internal bleeding.
The liver is protected by the ribs. However, blunt force trauma to the ribs can cause them to fracture. At times, the ribs might break and pierce the organs located in the abdomen. The ribs could fracture in the event of physical trauma or motor vehicle accidents.
Such injuries are likely to give rise to the following symptoms:
➻ Abdominal pain
➻ Swelling in the upper abdominal region
➻ Bruising of the affected region
➻ Pain that radiates to the shoulder
Grading of Liver Injuries
According to the AAST (American Association for the Surgery of Trauma), the liver injury grading system for liver trauma is
Hematoma: subcapsular, Less than 10% surface area; Laceration: capsular tear, Less than 1 cm depth
Hematoma: subcapsular, 10-50% surface area; Hematoma: intraparenchymal Less than 10 cm diameter
Laceration: capsular tear, 1-3 cm depth, Less than 10 cm length
Hematoma: subcapsular, more than 50% surface area, or ruptured with active bleeding; Hematoma: intraparenchymal, more than 10 cm diameter
Laceration: capsular tear, more than 3 cm depth
Hematoma: ruptured intraparenchymal with active bleeding
Laceration: parenchymal disruption involving 25-75% hepatic lobes or involves 1-3 Couinaud segments (within one lobe)
Laceration: parenchymal disruption involving more than 75% of hepatic lobe or involves more than 3 Couinaud segments (within one lobe)
Vascular: juxtahepatic venous injuries (inferior vena cava, major hepatic vein)
Vascular: hepatic avulsion
While Grade I refers to a mild injury, Grade VI indicates a very serious condition.
Diagnosis and Treatment
Besides a physical examination, other diagnostic tests might be conducted to determine the grading of liver trauma, and the extent of damage. A CT (Computed Tomography) scan is most commonly used for identifying a liver laceration. Magnetic resonance imaging (MRI), focal assessment sonogram in trauma (FAST), blood tests, liver enzyme tests, and liver function tests might also be conducted for determining the severity of the laceration.
In case of a mild laceration, the patient might be kept under medical supervision for at least 2 to 3 days. Bed rest is advised so as to lower the risk of complications. The patient must refrain from lifting heavy objects, or performing activities that might be physically strenuous.
Medical assistance must be immediately sought in case of a large laceration. Since a laceration causes bleeding, it is essential to monitor hemoglobin and hematocrit levels at regular intervals (may be after every six or twelve hours). In case of severe bleeding, blood transfusions might be recommended. After examining the overall health of the patient, the physician would perform a surgical procedure (laparotomy) for repairing the liver injury. This surgery is also necessary, if there is successive decline in the hemoglobin and hematocrit levels.
More often than not, liver injuries heal without any complications, which is why diagnostic tests are conducted to ascertain if the surgery is required or not. If the patient has undergone the surgery, he/she should religiously follow the guidelines given by the surgeon. The patient should take complete bed rest. It is advisable to avoid playing sports such as football, hockey, wrestling, basketball, baseball, soccer, etc., for at least six to eight weeks in case of a minor liver injury. These sports must at least be avoided for 3-4 months by those who had a severe liver injury. Basically, avoid performing strenuous physical activities for the duration suggested by the surgeon. If the surgeon has asked you to take certain drugs, take them in the prescribed dosage for the duration recommended by the surgeon. Also, follow-up visits are mandatory for monitoring the recovery process.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.