Hepatic Trauma (Blunt)


Background
  1. Injury to liver caused by blunt force to abdomen
  2. Liver is most commonly injured intra-abdominal organ
  3. More common in males
  4. Overall mortality 10%

Pathophysiology:

  1. Injury mechanism:
  2. Etiology of injuries
  3. Anatomy:
  4. Injury Grades

Diagnostics

  1. History
  2. Symptoms
  3. Physical exam
  4. Diagnostic testing
  5. Diagnostic imaging
      • Positive if:
        • >10 cc gross blood, enteric contents
        • Bloody lavage effluent
        • >100,000 RBC/mm3 or >500 WBC/mm3
        • Amylase >175 IU/dl
        • DPL fluid exits through CT or Foley catheters
        • Bacteria, vegetable fibers or food present

Differential Diagnosis

  1. Rupture of hollow viscus/intestinal injury
  2. Splenic trauma
  3. Pancreatic trauma
  4. Kidney trauma
  5. Pelvic fracture
  6. Abdominal wall injury

Treatment

  1. ATLS as usual
  2. FAST scan / DPL
  3. NG tube / foley PRN
  4. Serial exams
  5. Hemodynamic stability
  6. Further treatment
  7. Complications

Disposition

  1. All patients are admitted