Liver injury is hepatic injury sustained by the liver due to direct force or trauma caused to the abdomen. These are called blunt injuries. Range of hepatic injuries includes small capsular lacerations, subcapsular hematomas, major crush injury, vascular avulsion and deep parenchymal lacerations. Hepatic injuries have at least 6 grade classifications:
Grade 1: Laceration = 1 cm deep; subcapsular hematoma < 10% of surface area
Grade 2: Laceration = 3 cm deep < 10 cm long; subcapsular hematoma < 50%
Grade 3: Laceration > 3 cm deep; subcapsular hematoma > 50%; intraparenchymal hematoma > 10 cm
Grade 4: Parenchymal disruption < 75% of hepatic lobe; couinaud segments > 3
Grade 5: Parenchymal disruption > 75%; couinaud segments > 3; Juxtahepatic venous injuries
Grade 6: Hepatic avulsion
The location of the liver under the diaphragm and its large size makes it vulnerable to any blunt force. Injuries could be penetrating or non-penetrating. Penetrating injuries are caused when a foreign object such as a knife or a bullet from a gunshot penetrates the liver and causes damage. Non-penetrating injuries are a result of impact such as a car accident.
Some common causes are:
Angiography A thin, flexible tube called a catheter is placed into a vein to assess the blood flow to the liver inside the abdomen.
ERCP ERCP is endoscopic retrograde cholangiopancreatography in which a dye is put into the bile duct through an endoscope to detect injuries, stones and tumors.
CT Scan A computerized tomography uses a dye which flows through the IV in the vein to take pictures of the abdomen and the pelvis and scan for potential problems.
X-ray X-rays are taken to look for broken bones in the body inclusive of the pelvis, chest and abdomen.
Abdominal Ultrasound A gel is applied on the abdomen and a sensor is moved across the abdomen. The sound waves pick up pictures from the abdomen into a small monitor.