Liver Trauma
Liver trauma has high potential for morbidity and mortality due to both massive haemorrhage and risk of delayed complications, and is graded:
- Grade I
- Subcapsular haematoma <10% of surface area
- Laceration <1cm deep
- Grade II
- Subcapsular haematoma 10-50% of surface area
- Intraparenchymal haematoma <10cm
- Laceration 1-3cm deep
- Grade III
- Subcapsular haematoma >50% of surface area
- Intraparenchymal haematoma >10cm
- Laceration >3cm deep
- Vascular injury with bleeding contained within parenchyma
- Grade IV
- Laceration with parenchymal disruption of 25-75% hepatic lobe or 1-3 segments
- Vascular injury with bleeding into the peritoneum
- Grade V
- Laceration with >75% of parenchymal disruption
- Juxtahepatic venous injury
Epidemiology and Risk Factors
Pathophysiology
Aetiology
Clinical Manifestations
Diagnostic Approach and DDx
Investigations
Bedside:
Laboratory:
Imaging:
Other:
Management
Majority are managed non-operatively.
Resuscitation:
Specific therapy:
- Pharmacological
- Procedural
- Physical
Supportive care:
Disposition:
Preventative:
Marginal and Ineffective Therapies
Anaesthetic Considerations
Complications
Rate associated with ↑ grade of injury:
- G
- Hepatic necrosis
- Hepatic abscesses
- Bile leak
- Acalculous cholecystitis
- Delayed haemorrhage