![]() ![]() Radiologic findings are used to grade the degree of liver injury as defined by the American Association for the Surgery of Trauma (AAST) Hepatic Injury Scale. While magnetic resonance cholangiopancreatography (MRCP) does not have a role in the acutely injured trauma patient because of its time-consuming nature, it may play a role in patients where bile duct injury or leak is suspected. The trauma surgeon must correlate radiologic findings with a clinical presentation to guide management and take into account hemodynamic instability or peritoneal signs. This may help the clinician decide if the patient may benefit from angiographic embolization or surgical intervention. Administering IV contrast with CT scan allows for identification of patients with active extravasation of blood as evidenced by a blush on the CT from the liver. It also allows the clinician to identify other abdominal injuries and quantify hemoperitoneum. CT allows for the identification of hepatic injury and grading of severity. It is the best modality for identifying hepatic injuries. CT scan of the abdomen and pelvis with intravenous (IV) contrast has become almost routine in the hemodynamically stable abdominal trauma patient. Patients who have responded to resuscitation and are hemodynamically stable in the trauma bay can have further imaging to help guide treatment. It can guide management in the trauma bay and help clinicians decide if patients with liver injuries should proceed directly to the operating room. The FAST exam is highly operator dependent, and its sensitivity and specificity ranged from 63% to 100% and 95% to 100%. It does not identify the degree of organ injury. The FAST exam is used to identify the presence of blood in the abdominal cavity or pericardial sac. Radiologic assessment can also begin in the trauma bay with a focused assessment with sonography for trauma (FAST) exam. In addition, liver function tests may be abnormal, although this may not be seen until several hours to days after injury. Trauma patients with the appropriate mechanism of injury that are seen in the trauma bay should receive a standard set of laboratory tests. This may include but is not limited to a comprehensive metabolic panel, complete blood count, coagulation parameters, and lactate level. ![]() ![]() ![]() Patients with the liver injury can have right upper quadrant tenderness, and the presence of abdominal distention can suggest hemoperitoneum. For patients with hepatic injury, the primary survey should identify the presence of hypovolemic shock from liver bleeding. Vital sign changes present in hemorrhagic shock include a narrow pulse pressure, hypotension, and tachycardia.Īfter the primary survey is completed, the secondary survey should be conducted by performing a head-to-toe exam that can identify any potential injuries. The primary survey should be conducted to identify immediately life-threatening injuries. As with all trauma patients, the evaluation must be guided with advanced trauma life support principles. Trauma to the anterior or lateral wall or thoracoabdominal region may raise the suspicion of a possible hepatic injury. Care of the patient with hepatic injury often begins in the trauma bay. First responders can give provide crucial information regarding the mechanism of injury that may help the clinician discern whether a liver injury may exist. ![]()
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