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Hepatic Injury

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

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  • 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 2nd most commonly injured in blunt abdominal trauma, 2nd 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.


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

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Rosen, Peter, et al., editors. "Hepatic Injury." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307285/all/Hepatic_Injury.
Hepatic Injury. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307285/all/Hepatic_Injury. Accessed April 25, 2019.
Hepatic Injury. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307285/all/Hepatic_Injury
Hepatic Injury [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307285/all/Hepatic_Injury.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hepatic Injury ID - 307285 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307285/all/Hepatic_Injury PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -