Abdominal Injury : Liver Injury
The liver is the second most commonly injured abdominal organ in cases of BLUNT abdominal trauma (the spleen being first). It is also a frequently injured organ in PENETRATING trauma (stab wounds and gun shot wounds) due to its relatively large size. The liver is a very vascular organ and will bleed profusely when it is injured. The liver is located in the right upper quadrant of the abdomen, beneath the rib cage. Any BLUNT trauma to this area (kick, fall, seatbelt, etc.) could result in damage to the liver. Right lower chest injuries, particularly those which fracture ribs 7, 8, 9, or 10, can also result in a liver injury.
Common symptoms of liver injury include: persistent right upper quadrant pain, fainting, nausea or vomiting, and lightheadedness upon standing. Right upper quadrant pain may also increase in severity with deep breathing. In more serious cases, findings may also include a rapid pulse (greater than 100 beats per minute) and low blood pressure in more serious cases.
Evaluation will include physical examination for tenderness to palpation in the right upper quadrant of the abdomen. Abnormalities of blood pressure and pulse will be noted (low blood pressure and pulse over 100). Chest x-ray and abdominal x-rays will be performed in most cases. The CBC may show evidence of blood loss. CT-scanning of the abdomen can show the extent of liver injury live with an x-ray. Unstable patients, with classic findings of liver injury, may go directly to the operating room for surgical exploration and repair.
Diagnostic peritoneal lavage has proven an effective tool in evaluating patients with suspected liver injury. Hospitalization and observation is common for those patients with suspected internal abdominal injury--even if immediate operation is not necessary. The General Surgeon is the expert in the management of this problem.
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