Hepatic Injury

Hepatic Injury is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • The size and location of the liver places it at significant risk for injury:
    • The liver is the solid organ most frequently injured in penetrating trauma
    • The liver is the second most commonly injured in blunt abdominal trauma, second to the spleen
    • Highly susceptible to blunt injuries, by direct blow or deceleration forces
  • Mechanism of injury and description of forces are important factors in evaluating patients for possible hepatic injury:
    • Blunt trauma:
      • Obtain information about the forces and direction (horizontal or vertical) of any deceleration or compressive forces
    • Penetrating trauma:
      • Type and caliber of the weapon
      • Distance from the weapon
      • Variety and length of knife or impaling object
  • Hepatic injuries are graded by severity, ranging from subcapsular hematoma and lacerations to severe hepatic fragmentation
  • Associated conditions include rib fractures and injuries to the spleen, diaphragm, kidney, lung, gallbladder, pancreas, and blood vessels
  • Overall mortality of hepatic injury is reported at 8–10%
  • More often nonoperative management is becoming more common in isolated blunt hepatic trauma

Pediatric Considerations
Poorly developed musculature and relatively smaller anteroposterior diameter increase the vulnerability of liver to compressive forces in children

Etiology

Trauma:
  • Blunt mechanism:
    • Deceleration
    • Acceleration
    • Compression
  • Penetrating mechanism:
    • Stab wound
    • Gunshot wound
    • Impaled object

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Basics

Description

  • The size and location of the liver places it at significant risk for injury:
    • The liver is the solid organ most frequently injured in penetrating trauma
    • The liver is the second most commonly injured in blunt abdominal trauma, second to the spleen
    • Highly susceptible to blunt injuries, by direct blow or deceleration forces
  • Mechanism of injury and description of forces are important factors in evaluating patients for possible hepatic injury:
    • Blunt trauma:
      • Obtain information about the forces and direction (horizontal or vertical) of any deceleration or compressive forces
    • Penetrating trauma:
      • Type and caliber of the weapon
      • Distance from the weapon
      • Variety and length of knife or impaling object
  • Hepatic injuries are graded by severity, ranging from subcapsular hematoma and lacerations to severe hepatic fragmentation
  • Associated conditions include rib fractures and injuries to the spleen, diaphragm, kidney, lung, gallbladder, pancreas, and blood vessels
  • Overall mortality of hepatic injury is reported at 8–10%
  • More often nonoperative management is becoming more common in isolated blunt hepatic trauma

Pediatric Considerations
Poorly developed musculature and relatively smaller anteroposterior diameter increase the vulnerability of liver to compressive forces in children

Etiology

Trauma:
  • Blunt mechanism:
    • Deceleration
    • Acceleration
    • Compression
  • Penetrating mechanism:
    • Stab wound
    • Gunshot wound
    • Impaled object

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