The liver is an internal human organ, responsible for important functions of the body. For the normal operation of internal systems, a healthy state of the body is necessary. However, not only the toxic effect of toxic substances can damage the liver. A liver injury received during a blow or a fall can damage the integrity of the blood vessels and structures of an important organ, and if first-aid and medical care is delayed, the injury can lead to death.

Depending on the manifestations of an external nature and the formation of other symptoms associated with the well-being and general condition of the patient, narrower criteria are distinguished that conditionally divide liver injuries into several categories.

Depending on the cause of the appearance of blood in the abdominal cavity:

1. Bile duct injury.
2. Vessels passing inside the liver.
3. Vessels outside the liver.

Depending on the injuries in the internal region or with violations of the integrity of the fibrous membrane, the injuries are divided into two groups.

If the fibrous membrane of the abdominal organ was not damaged, the injuries are divided into categories:

• bleeding is under the capsule of the liver;
• hematomas and bleeding are formed in the central region of the organ.

If the fibrous membrane of the abdominal organ is damaged, the injuries are divided into categories:

• the formation of one or more cracks;
• crushing of the liver;
• division of the organ into segments that are inferior in function;
• the formation of large damage to the bile ducts;
• gallbladder damage;
• damage to the gallbladder and biliary system of an individual nature (without injuries to the segment of the liver).

The signs that appeared in the first hours after the injury indicate the degree and severity of the injury, since, in addition to classification by localization, injuries are divided according to the severity of the injury:

• closed injuries of the internal organ, the depth of which does not exceed 2 cm;
• the depth of damage reaches half of the entire thickness of the organ;
• the depth of damage exceeds half of the thickness of the organ;
• there is a division of the liver into fragments due to the person receiving multiple ruptures.

Timely treatment of the injured patient to a medical institution for examination or calling an ambulance is the most important stage in recovery and even saving a person's life. especially dangerous due to the lack of protective structures of the skeleton and the presence of large blood vessels.

ICD 10 injury code

ICD 10 is an international classification of infectious diseases, injuries and congenital pathologies of the human body. The last changes to the characteristics of the classification were made in 2016.

According to ICD 10, liver injuries belong to the block "Injury of the abdominal organs (S36)", and has its own section "S36.1 - Injury to the liver or gallbladder".

Causes

The human body is a very delicate and fragile mechanism, which makes many factors affecting the outside world harmful to the health and general condition of people. So, a liver injury is possible as an independent phenomenon, and as an accompanying injury.

Causes of liver injury:

• traffic accident;
• fall impact;
• a blow with a blunt object to the abdomen (a blow to the stomach without external damage to the skin);
• squeezing the human body between two objects;
• excessive tension in the abdominal muscles in infants;
• lifting a lot of weight;
• internal disorders of the structure of the organ and liver disease.

In the case when, during damage, hematomas (bruises) of various sizes form on the liver and neighboring tissues - such manifestations are associated with trauma to the blood vessels and functional parts of the internal organ.

Diseases of the ODS (musculoskeletal system) provoke the development of bone fragility, skeletal diseases are a common cause of violations of the integrity of internal organs during fractures.

Symptoms

Liver contusion is characterized by noticeable symptoms, the definition of which allows you to save a person's life.

Symptoms of a liver injury:

1. Pain symptoms with such an injury are characterized by a stabbing character and varying degrees of manifestation (from severe to mild pain). Pain is concentrated in the area of ​​the injury (on the right side) and intensifies during movement and changes in body position.
2. If a person has received multiple injuries, the pain spreads to the entire abdomen, lower back and inguinal zone (diagnosis depends on the cause that led to the appearance of disorders and the primary zone of injury).
3. The injury is accompanied by massive internal bleeding. Accumulation of blood in the abdominal cavity - this symptom can be single (without painful manifestation) due to the occurrence of traumatic shock of 2 or 3 degrees.
4. After liver damage, blood pressure rises significantly, but after blood begins to accumulate in the abdominal cavity, and blood loss reaches 800 ml, blood pressure decreases markedly.
5. Change and violation of the heartbeat, pulse fluctuation.
6. In the event that damage to the intestines has formed during the injury, bloating is possible.
7. Tension of the abdominal muscles and their lack of mobility during breathing.
8. Symptom of Shchetkin-Blumberg - cutting pain that occurs after a certain period of time after injury, the pain appears when the pressure of the hand decreases during diagnosis-palpation.
9. Kulenkampf's symptom - general softness of the abdominal wall or slight tension.
10. After a few days after the injury, there are signs of jaundice (discoloration of the skin and mucous membranes, yellow tint of feces and urine, itchy sensations on the skin), leukocytosis, fever up to 37-38 degrees, an increase in the size of the internal organ. Symptoms appear in the absence of diagnosis and treatment within 2-3 days.

It should be noted that the appearance of clinical symptoms of damage in children may appear much later than in an adult.

First aid

First aid after an injury is an important step in saving the life and health of the victim.

It often happens that after receiving a liver injury, the patient is in a state of severe pain shock, or unconscious - in this case, the first step is to return the patient to consciousness.

What to do with a liver injury:

1. Lay the victim down so that it is comfortable, but without pressure on the abdomen.
2. Apply ice to the injury site.
3. Apply pain-relieving injections (do not take drugs and liquids inside, as they can increase the load in the abdomen).
4. After an injury in the abdominal cavity of the victim, blood begins to accumulate, therefore, in order to provide assistance and diagnose possible ruptures, it is necessary to call an ambulance or take the patient to a medical facility.

Hospitalization is necessary due to the use of an oxygen mask and other means of resuscitation. In the event of a delay that lasts several days (depending on the severity of the damage received, the time is reduced), a lethal outcome for the victim is possible.

Diagnostics

Liver injury and gallbladder damage are diagnosed in a medical facility using:

• ultrasound examination (ultrasound);
• computed tomography;
• laparoscopy.

Treatment for liver injury is determined after determining the degree of damage.

Treatment

After the diagnosis, the doctor prescribes a method of treatment:

1. Intravenous administration of fluid into the body.
2. Surgery is being performed. During severe closed liver injuries, an outpouring of blood into the abdominal cavity is likely, in which case an operational stop of bleeding is carried out and, in some cases, even removal of a section of the organ. Reinfusion is carried out (transfusion to the patient of his own purified blood).
3. Therapy with medications (including taking antibiotics).
4. Rehabilitation course (observation in the dispensary for a month).

Note!

Self-medication and the use of folk methods for liver damage are strictly prohibited. Even taking into account the high level of organ tissue regeneration, the diagnosis and elimination of internal damage is vital.

Indications for surgical intervention include:

• the formation of a closed injury with severe bleeding;
• development of anemia within 3 days after injury;
• hemobolia;
• bilihemia;
• liver abscess;
• separation of a segment of the internal organ.

Monitoring the patient's condition in a hospital allows you to provide quick assistance in case of complications in the later stages of rehabilitation.

Complications and consequences

A liver injury has serious consequences if the rules of treatment are not followed or if assistance is not provided in time.

Possible complications:

1. Tissue necrosis, sepsis.
2. Hemobilia, bilihemia.
3. The development of an abscess (suppuration in the area of ​​​​the hematoma).
4. Formation of a cyst in the tissues of the liver.
5. Subdiaphragmatic abscess.
6. Liver failure, intrahepatic abscess, bleeding of liver vessels.
7. Bleeding in the first 3 days after surgery or diagnosis.
8. fibrinolysis.
9. Peritonitis.
10. Decreased mobility of the dome of the diaphragm in the right area.
11. Change in the position of the colon and stomach.

The cause of serious consequences can also be home treatment and unwillingness to consult a specialist. It is important to remember that complications of liver injury must be treated immediately after the first signs appear, otherwise a fatal outcome is possible.

Liver injury does not cause cancer.

Conclusion

Liver contusion is a severe injury that may be accompanied by severe hemorrhage in the abdominal cavity and disruption of the gallbladder. Treatment takes a long time and requires the use of complex surgical operations. Timely provision of pre-medical and medical care can improve the general condition of a person and save his life.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you survived a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

During accidents, not only external injuries are possible, which are diagnosed at the sight of a wound or an unnatural position of the limb, but also injuries to internal organs that pose a threat to the life of the victim due to the difficulty in diagnosing them. Sometimes they can be diagnosed only after a considerable time after the injury.

With injuries, ruptures of internal organs often occur, accompanied by severe internal bleeding. This happens if internal organs that contain large amounts of blood, such as the liver, kidneys, or spleen, are damaged. However, there are also injuries in which, as a result of a blow, severe tissue damage occurs, cells die, and the organ cannot function normally.

Symptoms

• Strong pain.
• Tense anterior abdominal wall.
• Feeling of fullness in the stomach.
• Hemoptysis.
• Shock symptoms.

The organs of the chest or abdomen can be injured by some sharp or blunt object during a traffic accident, for example, when the driver hits the steering wheel with his chest or stomach, or when a person falls on his chest or back. In addition, gunshot or stab wounds are possible.

Treatment

In case of injuries of internal organs, the patient needs urgent medical care. It is necessary to resort to intensive care measures as soon as possible. Usually such patients have to be urgently operated on to stop internal bleeding. In addition, only during the operation, the doctor can carefully examine and accurately determine the degree of damage to internal organs. Stopping bleeding depends on the degree of damage and its location; for example, damaged blood vessels can be cauterized with an electrocautery, pulled together, or stitched together with threads.

Stop bleeding

Bleeding (with a large area of ​​the wound) can be stopped with drugs, such as fibrin glue, or cauterization using electricity. If the tissues are so severely affected that they are not capable of regeneration, then the organ must be urgently removed without waiting for tissue death (necrosis) and poisoning of the whole organism with decay products. In case of damage to internal organs, the patient almost always has to inject preserved blood by drip and resort to measures to stabilize blood circulation. In addition, it is extremely important to ensure the vital functions of the body (respiration, heart function).

First aid for injuries of internal organs

The person providing first aid can give the body of the victim the position of a "folding knife" (put the victim on his back, slightly raising his legs). If the patient is excited and frightened, then it is necessary to try to calm him down. In case of damage to the lungs, the patient should be laid on his back so that the upper body is slightly elevated. All other therapeutic measures can only be applied by a doctor.

In case of pain in the abdomen or chest and the slightest suspicion of damage to the organs of the chest or abdominal cavity after an accident, you should immediately consult a doctor. With symptoms of shock, you should immediately call an ambulance. Symptoms of shock may include paleness, cold sweats, palpitations, and shallow, shallow breathing. Severe pain is also an important symptom of injuries of internal organs. The presence of damage to the abdominal organs can also be assumed from the tense anterior abdominal wall. If the lungs are damaged, the victim vomits or hemoptysis with light-colored foamy blood. With gastric bleeding, the patient feels fullness in the stomach and nausea.

After learning the circumstances of the incident and evaluating the symptoms of the injury, the doctor will establish a diagnosis and resort to appropriate therapeutic measures.

If an emergency operation is necessary, the doctor tries to take all necessary measures to save the damaged organ. However, during subsequent reoperation, the dead parts of the organ often have to be removed.

From the anamnesis, the mechanism of injury, the position and state of the body at the time of injury, the direction and force of the blow, the state of the abdominal wall at the time of injury (muscle tension or relaxation), the degree of filling of the gastrointestinal tract with food and fluid preceding the injury, and diseases of the abdominal organs are ascertained from the anamnesis. . Subjectively, patients complain of pain, general weakness, nausea, less often - vomiting. Pain sensations can be in the first hours without a specific localization, throughout the abdomen or with a predominance in the upper or lower sections. Often, pain is associated with rib fractures with concomitant chest injuries (after intercostal blockade with novocaine, these pains disappear). The diffuse nature of pain is typical for rupture of the intestines, mesentery, intracavitary or retroperitoneal bleeding. Localization of pain in the right or left hypochondrium with irradiation to the shoulder of the same name is characteristic of damage to the liver and spleen.

The duration and intensity of pain are important in the diagnosis. If the intensity of pain subsides 2-3 hours after the injury and the victim's condition improves (hemodynamics and respiration normalize), then with a high degree of probability damage to the internal organs can be excluded (in the absence of objective signs of internal bleeding and peritonitis). If the pain progressively increases, becomes diffuse, indications for laparotomy should be set (even in the absence of objective signs of intra-abdominal pathology). It should be remembered that with local injuries of the intestines, patients can walk for a long time, seek medical help on their own, and feel quite satisfactory. However, gradually, increasing with each hour, they develop signs of peritonitis.

Signs of severe shock in the first 1.5-2 hours after injury indicate massive internal bleeding, the source of which is often a rupture of the spleen or liver. At the same time, the pulse becomes threadlike, 130-140 beats per minute, there is a sharp (dead) pallor of the skin and mucous membranes, a decrease in the temperature of the limbs, ears, nose, forehead, and cold sweat appears. Psychomotor agitation (with low or indefinite pressure) confirms the diagnosis and serves as a formidable harbinger of the approaching death of the victim. Patients may complain of increasing tinnitus, dizziness, excruciating thirst, lack of air. Their abdomen is swollen, moderately tense and painful. Only an emergency operation can save the patient.

One of the reliable signs of intra-abdominal damage is the absence of abdominal breathing (or, as they say, the stomach does not participate in the act of breathing). Another reliable sign is a pronounced tension (rigidity) of the abdominal wall. The stronger this tension, the more likely the rupture of the internal organ. With a sharp tension of the abdomen (“like a board”), an intra-abdominal catastrophe is beyond doubt. The absence of noises of intestinal peristalsis (auscultatively) in the first hours after the injury indicates more about intra-abdominal bleeding, in the later stages (2-3 days) "deathly silence" of the abdomen indicates diffuse peritonitis. Symptoms of peritoneal irritation (Shchetkin-Blumberg symptom, etc.) are not specific to abdominal injuries, but they always indicate an acute irritant in the abdominal cavity. The combination of these symptoms with other objective and subjective data significantly increases the reliability of the diagnosis.

Vomiting is a frequent symptom of intra-abdominal damage; in the early period, it is associated with irritation of the vagus nerve, and in the late period, with intoxication of the body. The symptom of "roly-up" should always be alarming - the patient's desire to return to his previous position after turning over on his back, the other side, etc. This phenomenon is based on a sharp increase in pain from irritation of new areas of the peritoneum by the outflowing contents of the gastrointestinal tract or blood (even in small quantities). The appearance of dullness in the sloping areas of the abdomen indicates the presence of fluid in the abdominal cavity. This sign becomes distinct with the accumulation of about 1 liter of fluid. If blood accumulates, then objective signs of massive blood loss should be simultaneously determined. The reliability of the sign increases if the fluid boundary moves when the patient's position changes.

A simple but very informative diagnostic technique is bladder catheterization (especially with concomitant pelvic fractures). A full bladder can obscure the clinical picture of damage to the abdominal organs, the absence of urine can be the cause of intra-abdominal rupture of the bladder, the presence of blood in the urine is a consequence of kidney damage.

Rectal digital examination can also be very informative. This is the only method of direct palpation of the peritoneum. Accumulation of blood or other fluid in the rectovesical cavity in men or in the utero-rectal cavity in women can be directly palpated through the rectum and thus definitively confirm the diagnosis.

An X-ray examination can be of great help in the diagnosis, if the general condition of the patient allows you to turn him on his side or give the body a vertical position. It is possible to detect in the X-ray picture of the abdomen shadows corresponding to fluid in the free abdominal cavity, and enlightenment in the form of a strip, sickle in the subdiaphragmatic spaces or along the lateral surface of the abdomen (when the patient is on his side).

In a laboratory blood test, a decrease in hemoglobin, hematocrit, the number of erythrocytes, and an increase in the number of leukocytes can be established. In the early period, these changes are not typical, but the determination of these indicators in dynamics will undoubtedly be useful for clarifying the diagnosis. Additionally, you can determine the mass of blood and calculate the estimated amount of blood loss from nomograms.

The most reliable method for diagnosing damage to the abdominal organs is a diagnostic laparotomy. Visually determine the nature and extent of intra-abdominal injuries, stop bleeding, restore the integrity of internal organs.

Refusal of this method should be strictly justified, since expectant tactics can be fatal for the patient. The accuracy of diagnosis is significantly increased by laparoscopy and laparocentesis.

A child can be injured in the chest and abdomen (abdominal organs) when falling from a height, from a bicycle, in a traffic accident.

Another common cause of such injuries is the fights of teenagers. Modern teenagers, brought up on the examples of "cool" movie heroes, straying into flocks, form an aggressive crowd that does not know pity and indulgence, capable of unreasonably beating and mutilating its victim. As a result of bloody showdowns, children with severe injuries, often leading to disability and a tragic outcome, enter the trauma department.

It is necessary to be able to timely and correctly provide first aid and emergency care to the child.

Chest bruises are most common: while running, the child ran into a door frame, hit sideways on the corner of a table or desk, falling from a bicycle, touched the steering wheel with his chest, etc. There is pain at the site of injury, sometimes swelling and hemorrhage. The pain intensifies with a deep breath, coughing and probing the bruised area. For several days, the child will spare the injured half of the chest, frown with awkward movements, but the pain will gradually subside, and after 7-10 days there will be no trace of the injury.

No special treatment is required for chest contusions.

With severe pain, you can give an anesthetic tablet (analgin, aspirin, ortofen, nurofen, efferalgan) and rub the ointment into the injury site (finalgon, indomethacin, long-cream).

Clavicle fracture

Clavicle fracture in children, it is one of the most common injuries, accounting for 13% of fractures of the extremities and yielding in frequency only to fractures of the bones of the forearm. The mechanism of injury may vary, but most often the fracture occurs in a fall on the shoulder or outstretched arm. Depending on the degree of displacement, complete or incomplete (subperiosteal) fractures are distinguished. The latter form is more common in newborns and young children, so it is easily visible.

30% of clavicle fractures occur between the ages of 2 and 4 years.

Deformation and displacement with incomplete fractures clavicles absent or minimally expressed. The function of the hand is preserved, only its abduction above the level of the shoulder girdle is limited. The pains are unexpressed, so such fractures are often not detected and the diagnosis is made after 10-15 days, when a callus is found in the form of a significant thickening on the collarbone.

For complete fractures there is a displacement of fragments, so the recognition of a fracture is not difficult.

Treatment consists in matching the fragments and fixing them in the correct position. For small children, a Dezo bandage is applied, bandaging the arm to the body for 7-10 days. In older children, a stronger fixation is needed with the shoulder retracted and the external fragment of the clavicle raised. Fusion of fragments of the clavicle in older children occurs within 2-3 weeks.

Fractures of the sternum and ribs

Fractures of the sternum and ribs in childhood are rare due to the elasticity and good cushioning of the rib cage in case of injury, and occur under the influence of strong blows or falling on hard objects. There is a sharp pain, aggravated by movement, deep inspiration, palpation of the affected area. Breathing becomes shallow and rapid. The patient takes a forced position, facilitating his condition as much as possible, and tries not to move. In this position, you will deliver him to the traumatologist.

Dangerous complication of rib fracture is damage to the pleura and lung tissue by sharp bone fragments and the development pneumo- or hemothorax(entry of air or blood into the pleural cavity). This severe and life-threatening complication is important to recognize in the first minutes, as the deterioration of the condition develops very quickly. Air and blood, accumulating in the pleural cavity, press the lung up, turning it off from the breathing process. Sometimes air from the pleural cavity enters under the skin, swelling of the neck, chest occurs, and when the skin is palpated, a sound similar to the creaking of snow occurs. This sign reliably indicates that air is present under the skin. An intact lung works for two, breathing becomes frequent and shallow, the patient feels shortness of breath, lack of air, becomes pale, covered with cold sticky sweat, lips and fingertips turn blue, which indicates respiratory failure. The heart rate increases, and for some time keeps the blood pressure, but soon it drops, and then development is possible.

The victim needs immediate surgery, without it he will die in a matter of hours.

Penetrating wounds of the chest

For penetrating chest wounds affecting the lung tissue, air enters the pleural cavity and under the skin not only from the respiratory tract, but also from the environment as a result of the suction action of the chest. Each respiratory movement is accompanied by extraneous sounds that occur at the site of injury. And with each breath the patient's condition worsens. Before transporting the patient to the hospital, it is necessary to close the wound with an airtight bandage (cellophane, oilcloth) to exclude air absorption.

If the object with which it was applied sticks out of the wound (knife, screwdriver, scissors), do not remove it.

As long as it seals the wound, there is little risk of pneumothorax and bleeding. The victim is hospitalized in a semi-sitting or sitting position, so it is easier for him to breathe.

blunt abdominal trauma

Blunt abdominal trauma may be limited to a bruise of the abdominal wall, and with a strong blow, internal organs (liver, spleen, intestines) may suffer, up to their rupture, accompanied by internal bleeding.

Damage to internal organs is more often observed in boys, which is the result of their increased activity. The degree of damage to organs depends on their condition at the time of injury. Thus, a blow to the stomach after a heavy meal is more likely to rupture a hollow organ than a blow of the same force, but inflicted on an empty stomach. If the abdominal press is well developed, then at the moment of impact, muscle tension will protect the internal organs from extraneous influence.

Chance of internal bleeding

Internal bleeding does not always appear immediately. Sometimes, after an injury, the child gets up and does not complain, and palpation of the abdomen does not reveal any tension in the abdominal wall or pain. However, the child must be monitored because the symptoms of internal bleeding increase over several hours. There is weakness, lethargy, pallor, sometimes nausea and vomiting. When a hollow organ is ruptured, the child complains of severe pain throughout the abdomen, and repeated vomiting almost always joins. The clinical picture corresponds to peritonitis.

Rupture of the liver or spleen

If happened rupture of the liver or spleen, then the pain is not severe, and vomiting appears on the second or third day after the injury. Even more insidious are subcapsular ruptures of the liver and spleen. There was a rupture of the organ and bleeding from it, but the capsule was not damaged, so the blood accumulates under it, and there are no signs of internal bleeding. The child continues to lead an active lifestyle, and suddenly, after a few days, unexpectedly after a sharp movement, the capsule breaks, and blood is poured into the abdominal cavity. Therefore, with closed injuries of the abdomen, it is necessary to consult a surgeon, and in some cases, dynamic monitoring of the child in a hospital.

Penetrating abdominal trauma

Penetrating wounds of the abdomen are always a reason for hospitalization in the surgical department. We have already spoken more than once about the need to leave a foreign object in the wound that caused the injury. So in a panic state, do not pull the knife out of the wound. Apply a pressure bandage and take the child to the hospital. During transportation, the victim should lie with raised legs.

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