Angioembolization less common but available in select centers
Weight based dosing
Tranexamic acid pediatric protocol if used locally
Opioid dosing weight based with monitoring
Radiation minimization
Ultrasound first strategies where appropriate
CT when clinically necessary
Epidemiology
Trauma epidemiology
Liver as common solid organ injured in abdominal trauma
Frequent in blunt trauma with right lower rib injury
Frequent in penetrating right upper quadrant injury
Mortality drivers
Exsanguination early phase
Associated injuries and traumatic brain injury
Pathophysiology
Injury mechanisms
Parenchymal disruption
Capsular tear and bleeding from hepatic parenchyma
Segmental arterial and venous injury
Vascular injury patterns
Hepatic arterial branch injury
Contrast extravasation
Pseudoaneurysm formation
Juxtahepatic venous injury
Retrohepatic vena cava involvement
High mortality and operative complexity
Biliary injury patterns
Bile duct disruption causing leak
Biloma formation and infection risk
Therapeutic Considerations
Management principles
Nonoperative management
Preferred for hemodynamically stable blunt injury in equipped centers
Requires monitoring and rapid access to intervention
Angioembolization
Effective for arterial bleeding control in stable or transient responder patients
Complications include hepatic necrosis and bile duct ischemia
Operative management
Indicated for instability and peritonitis
Damage control strategies reduce mortality in severe bleeding
Evidence framework
Trauma society guidelines support nonoperative management in stable patients
Angioembolization recommended for CT blush in stable patients in many trauma guidelines
Copy discharge instructions
Home care and activity
Activity restriction
Avoid heavy lifting and contact sports until trauma follow up
Gradual return to activity based on symptom resolution and clinician clearance
Pain control plan
Use prescribed analgesics as directed
Avoid alcohol while taking opioids
Return to emergency criteria
Bleeding and shock symptoms
Fainting or near fainting
New severe weakness or confusion
Fast heartbeat with lightheadedness
Worsening abdominal symptoms
Increasing abdominal pain
New abdominal distension
Repeated vomiting
Infection and biliary complication symptoms
Fever
New jaundice
Dark urine or pale stools
Worsening right upper quadrant pain
Gastrointestinal bleeding symptoms
Vomiting blood
Black tarry stools
Follow up
Trauma clinic follow up timing per local protocol
Imaging follow up if recommended for high grade injuries or vascular lesions
Clinical guidelines and evidence sources
Trauma and hepatobiliary guidance sources
WSES guidelines on liver trauma
Nonoperative management in stable patients
Angioembolization for arterial blush
EAST practice management guidelines for blunt hepatic injury
CT based grading and monitoring
Selective use of angiography
AAST organ injury scale for liver
Standardized grading I to VI
Prognosis and intervention correlation
Resuscitation and transfusion guidance sources
Trauma massive transfusion and damage control resuscitation recommendations
Balanced component therapy strategy
Hypothermia acidosis coagulopathy prevention
CRASH 2 trial for tranexamic acid in trauma
Benefit when given within 3 hours of injury
Time to treatment effect gradient
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