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Hepatic Injury, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • The size and location of the liver places it at significant risk for injury:

    • The liver is the solid organ most frequently injured in penetrating trauma.

    • The liver is the 2nd most commo...

Diagnosis

Signs and Symptoms

Physical exam and history can be variable. 

History

History of trauma usually available from patient or pre-hospital providers 

Physical Exam

  • Neither sensitive nor specific for...

Treatment

Pre-Hospital

  • Obtain details of mechanism of injury.

  • Initiate large-bore IV access:

    • Hemorrhage may be rapid and life-threatening.

  • Moist saline dressings over penetrating wounds or evisceration

  • Dir...

Follow-Up

Disposition

Admission Criteria

  • All patients with hepatic injury require hospitalization for definitive laparotomy or close hemodynamic observation with serial exams or CT scans, as well as hem...

Pearls and Pitfalls

  • Obtain early surgical consultation in unstable patients.

  • Failing to obtain appropriate and adequate imaging studies is a pitfall.

  • Do not rely on negative US to rule out hepatic injur...

Additional Reading

  • Jacobs  IA, Kelly  K, Valenziano  C, et al. Nonoperative management of blunt splenic and hepatic trauma in the pediatric population. Am Surg.  2001;67:149–154.

  • Malhotra  AK, Fab...

Codes

ICD9

  • 864.00 Injury to liver without mention of open wound into cavity, unspecified injury

  • 864.10 Injury to liver with open wound into cavity, unspecified injury

  • 864.11 Injury to liver with open wou...

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