Liver Injury

By Philbert Yuan Van, MD, Oregon Health and Science University

Last full review/revision April 2017 by Philbert Yuan Van, MD 

 

Liver injuries are characterized in several key ways:

• People have tenderness and pain in the abdomen that sometimes radiates to the shoulder.
  
• Doctors use computed tomography (CT) or ultrasonography to detect liver injuries.
  
• Liver injuries often heal without treatment, but sometimes surgery is needed to repair the injury or to remove part of the liver.
  

(See also Overview of Abdominal Injuries.)

Causes

The liver can be damaged as a result of impact (for example, a motor vehicle crash) or penetrating trauma (such as a knife or gunshot wound). Injuries may range from relatively small collections of blood (hematomas) within the liver to large tears that go deep into the liver. Because the liver has many large blood vessels, the main problem resulting from liver injury is severe bleeding. Nearly all bleeding from a liver injury occurs within the abdominal cavity.

Symptoms

People with liver injury and severe bleeding have symptoms of shock, including a rapid heart rate, rapid breathing, and cold, clammy, pale or bluish skin. People also have abdominal pain and tenderness because blood in the abdomen irritates the abdominal tissue. When bleeding is severe, the abdomen may also be swollen.

Diagnosis

• Liver imaging tests
  
• Sometimes surgery
  

Doctors use computed tomography (CT) or ultrasonography to detect liver injuries. Sometimes surgery is needed to determine the extent of the injury and to stop the bleeding.

Treatment

• Manage internal bleeding
  

Sometimes liver injuries heal without treatment. However, people must be hospitalized and watched closely to ensure that bleeding does not worsen. Sometimes doctors give blood transfusions. If the bleeding worsens or does not stop fairly quickly, doctors often first try to seal off the bleeding vessels without surgery. To seal the vessels, doctors pass a thin plastic catheter into the blood vessels in the groin and then up to the liver. Then they inject substances to seal the vessels. If this procedure does not stop the bleeding, surgery is usually done. Also, if bleeding was very severe from the beginning, surgery is usually done as soon as possible because in such cases sealing off blood vessels without surgery is rarely effective.

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