Liver trauma

Reviewed and revised 21 December 2015

OVERVIEW

  • Liver trauma may result from blunt or penetrating abdominal injury
  • The liver is the most commonly injured organ in penetrating abdominal trauma

ASSESSMENT

  • Abdominal pain, localized tenderness (RUQ)
  • Possible hemorrhagic shock
  • CT abdomen with IV contrast is the investigation of choice (liver injuries are graded I to VI according to severity)

GRADING

American Association for Surgery of Trauma Organ Injury Scale based on:

  • haematoma size (% surface area)
  • laceration size (parenchymal depth)
  • vessel involvement
  • integrity of liver
  • vascular status

Grade          Description of Injury

I                       small (<10%, < 1cm)

II                     moderate (10-50%, < 10cm)

III                    large (>50%, > 10cm or expanding)

IV                     large with parenchymal disruption (>25% of a hepatic lobe)

V                      large with parenchymal disruption (> 75% of a hepatic lobe) or juxtahepatic venous injury

VI                     hepatic avulsion

MANAGEMENT

  • ATLS approach
  • Most haemodynamically stable injuries can be managed non-operatively
  • Angiography with embolization should be considered if:
    — a contrast blush is seen on CT
    — evidence of ongoing bleeding
  • Operative management may initially adopt a damage control approach with simple packing only followed by definitive procedure when haemodynamically stable
  • Interventional modalities may be used to treat complications such a biloma, hepatic abscess, etc (e.g. ERCP, percutaneous drainage, laparoscopy)

Reference and Links

FOAM and web resources


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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