The liver is the biggest organ occurring in the human body. It is one of the most vital organs and is located is the upper right quadrant of the abdominal region. A part of the organ is situated behind/under the ribs.
The liver performs a variety of different functions; it filters the blood of its impurities; it significantly contributes to all different metabolic processes in the body; it is actively involved in regulation of blood sugar levels; it has a role in production of urea and amino acids; and it secretes bile which helps neutralize stomach juices and acid thereby aiding the process of food digestion.
A tear or a cut in the liver can be termed as a lacerated liver. If the tear is big and deep then the laceration may trigger uncontrollable bleeding requiring emergency medical care. In case of minor or small cut, a lacerated liver can be treated with standard medical procedures and bed rest. It is important to note that all cases of lacerated liver need to be medically diagnosed and evaluated.
Symptoms of lacerated liver
The main symptom of a lacerated liver is a tear or cut in the organ. The associated symptoms are dependent on the severity of the tear or injury. Some of the common signs and symptoms of the condition are listed below:
- Both major and minor cases of lacerated liver may be accompanied by bleeding
- Patients may experience swelling and pain in the abdomen. Affected people may find it very difficult to bend due to the pain.
- The stomach area may be very tender to touch, more so on the right side.
- In case of a penetrating injury or wound, patients may suffer from bleeding from skin. Bruising may also occur on the abdomen.
- Abdominal pain may radiate upwards and cause discomfort and pain in the shoulders, especially the right side shoulder.
- In case of extreme hemorrhage, lacerated liver may produce all the signs of shock such as rapid heartbeat, weak pulse, sweating, dizziness, and low blood pressure.
Injuries of the liver are graded from 1 to 6. Minor injuries marked by trauma to just the outer lining of the organ is termed as grade 1 liver injury, while grade 5 and 6 are the serious kinds of liver injuries characterized by deep wound that affects a large section of the organ.
Causes of lacerated liver
A lacerated liver is commonly caused due to the below listed reasons:
- It can occur due to any kind of blunt traumatic impact or injury on the abdomen over the liver region. This kind of injury may happen when the area is hit by a blunt object, a strong blow, or a blunt surface. The blunt trauma may then cause a bruise, tear, or cut in the liver.
- It may be noted that blunt injury to liver may damage the organ even when there is no tear/cut on the skin. It can be termed as a kind of contused injury.
- The ribs protect the liver. Blunt trauma or force on the ribs may sometimes result in their fracture. The broken ribs may then puncture the organs present in the abdomen, like the liver.
- Motor accidents, falls, contact-sports injuries, etc, may cause this type of lacerated liver.
- Liver laceration may occur due to some kind of penetrating wound or injury caused by any kind of sharp object like a bullet or a knife. When these sharp objects penetrate and cause cuts or tears in the liver, then a lacerated liver may develop. There may be internal bleeding if there is rupture of blood vessels.
Liver injuries grading
Presented below is the grading system for liver trauma as per classification done by the American Association for the Surgery of Trauma/AAST:
- Grade I: In this, hematoma is subcapsular and under 10 percent of liver surface is affected. Laceration is capsular cut which is less than one cm deep.
- Grade II: In this, hematoma is subcapsular, 10 to 50 percent of liver surface is affected, and intraparenchymal hematoma is under 10 cm diametrically. Laceration is capsular cut which is less than 10 cm long and 1 to 3 cm deep.
- Grade III: In this, hematoma is subcapsular, over percent of liver surface is affected with bleeding, and intraparenchymal hematoma is over 10 cm diametrically. Laceration is capsular cut which is over 3 cm deep.
- Grade IV: In this, hematoma is marked by torn intraparenchymal along with bleeding. Laceration features parenchymal problems which involve one to three Couinaud segments in 1 lobe, or involve 25 to 75 percent hepatic lobes
- Grade V: In this, laceration features parenchymal problems which involve over three Couinaud segments in 1 lobe, or involve over 75 percent hepatic lobes. There are venous injuries which may involve major hepatic vein, inferior vena cava
- Grade VI: There is vascular hepatic avulsion
Treatment of lacerated liver
Treatment of lacerated liver is dependent on diagnosis of the extent of organ injury. Doctors will check the medical history of the patient, conduct a physical examination, and then recommend tests like MRI, CT scan, blood test, etc.
- For minor injury, affected people are placed in medical supervision and their vital signs are continuously monitored. When the symptoms improve, then doctor may discharge patient in 2 to 3 days.
- In extreme cases marked by excess blood loss, patients need emergency care as severe hemorrhage can lead to fatality. Severe cut to the organ may be surgically corrected.
