Injuries to the abdominal organs are one of the most difficult varieties, since in most cases they pose a threat to the lives of the victims. The causes of such damage can be traffic accidents, blows to the abdomen or a fall from an impressive height. In this case, liver ruptures most often occur, which is associated with the rather large size and structure of this organ. What is a liver rupture, how to provide assistance to victims and how will treatment proceed in a medical institution? You will learn the answer by reading this article.
Liver structure
Before proceeding with the characteristics of liver damage, it is worth saying a few words about the structure of this organ. What is the liver, where is this organ and how does it hurt? The liver is located in the upper part of the peritoneum, occupying the right hypochondrium. The mass of the liver of an adult reaches an average of one and a half kilograms. The organ has two surfaces: the upper, located directly below the diaphragm, and the lower.
The liver consists of two lobes: right and left. Shares are separated from each other by a crescent ligament. The gallbladder adjoins the liver, which is a reservoir for the bile secreted by the organ.
Liver function
The liver performs a number of important functions. It purifies the blood, reproduces various proteins necessary for normal functioning of the body, produces enzymes and takes part in all types of metabolism. During intrauterine development of a person, the liver performs hematopoietic functions. Moreover, many people know very little about it, for example, where the liver is located and how this organ hurts. This knowledge is very important: if you suspect the presence of a disease in time, treatment will bring much better results.
Traumatic lacerations
The liver has a fairly dense consistency, but this organ is damaged quite often. This is due to the fact that the liver is covered only by the abdominal wall (with the exception of the posterior surface of the organ). The thin peritoneum does not contribute to reliable protection from external influences. Many factors can cause liver rupture: the causes of this pathology are very diverse. For example, with injuries or bumps, the tissue can tear quite easily.
The liver can be damaged by injuries to the chest or lower back. Frequent rupture of the liver in an accident. A serious blow to the liver can provoke an injury. This is due to the specifics of the anatomical location of the organ, as well as its impressive weight. Since the liver is not elastic and is fixed between the ribs and the spine, it is damaged quite often.
In some cases, improperly performed cardiopulmonary resuscitation can lead to liver ruptures, but this is extremely rare.
Is spontaneous rupture of the liver possible?
There is a high risk of liver rupture in the event that the organ is affected by any disease. With malaria, syphilis, amyloidosis, even mild external influences can lead to rupture. Such damage can cause not only a blow to the liver, but also tension in the muscles of the press, for example, when coughing. Spontaneous liver ruptures can be observed in the presence of malignant neoplasms in this organ or with vascular aneurysms.
Liver rupture can occur during pregnancy. This pathology has been described about 120 times since 1844. However, most women were diagnosed with hypertension.
Classification of liver ruptures
By severity, these injuries are divided into 4 main categories:
- violation of the integrity of the capsule with slight bleeding;
- rupture of the parenchyma, in which bleeding quickly stops after the surgeon sutures;
- deep gaps in which the victims experience shock and loss of consciousness;
- rupture of the parenchyma, accompanied by a violation of the integrity of large vessels - with such an injury, a person can die quickly enough due to blood loss.
Biphasic, or delayed liver ruptures are also distinguished. With such injuries, a subcapsular or intrahepatic hematoma forms, which subsequently breaks into the abdominal cavity.
If a rupture of the liver is accompanied by a violation of the integrity of the fibrous membrane of the organ, then the blood enters the abdominal cavity. If there is damage to the diaphragm, then blood is detected in the pleural cavity. If the fibrous membrane is not damaged, then blood gradually accumulates between it and the parenchyma.
What threatens liver rupture?
Liver ruptures almost always pose a threat to the life of the victim. It can be either single or multiple: the intensity of bleeding depends on this factor. It is worth noting that the parenchyma and blood vessels of the liver are not able to contract. This causes the development of bleeding, which cannot stop spontaneously. Also, blood loss is amplified due to the fact that the liver constantly moves when breathing. In addition, bile is mixed with blood, which greatly complicates its coagulation. In rare cases, bleeding may stop without medical attention. As a rule, this happens when large vessels have not been destroyed.
Symptomatology
The main symptoms of a liver rupture include:
- Pain in the abdomen. The pain can be both subtle and sharp. Often, when the liver is damaged, the victim assumes a forced sitting position: when trying to change the pose, the pain becomes more intense (vanka-vstanka syndrome).
- The pain becomes stronger if the victim turns over to the left side: this is due to the fact that blood accumulated in the right side of the abdomen moves to the left side.
- The victim's lips may turn blue.
- After receiving an injury, the stomach is tense and retracted.
- Nausea and vomiting.
- The appearance of cold sweat, cooling the limbs.
- The victim may feel very thirsty.
- Pallor of the skin.
- Loss of consciousness, pain shock.
If the hematoma is small with a liver rupture, then the patient's condition is usually satisfactory. If the damage is more significant, then the patients are in serious condition. With a minor injury in the first days after receiving it, there are no symptoms. Usually the pain subsides after a couple of days, but the liver slightly increases. There may be a rise in temperature, sometimes a small jaundice develops. In the future, with any slight stress, capsule rupture may occur, with the hematoma pouring into the abdominal cavity.
Immediately after the injury, the pressure rises, but after the bleeding intensifies, it begins to decrease. It is believed that the pressure drop begins after the volume of blood loss reaches 800-1500 milliliters.
How is liver rupture diagnosed?
Diagnosis of liver rupture can be difficult, especially if the patient has other injuries. If the diagnosis of liver rupture is not made in time, the consequences can be very serious. Fortunately, thanks to modern diagnostic methods, errors are minimized.
Recently, for the diagnosis of liver ruptures, abdominal puncture with the introduction of a special catheter is used. Thanks to this method, it is possible to quickly identify the specifics of the injury and carry out the necessary therapeutic measures. Some patients are advised to have a liver ultrasound scan to make a correct diagnosis.
A blood test helps determine the intensity of the changes caused by blood loss. The number of red blood cells begins to decrease a couple of hours after the rupture has occurred, acute anemia subsequently develops. The rate of decrease in the number of red blood cells allows you to determine the intensity of internal bleeding. Blood tests should be performed every few hours, which allows you to track the dynamics of the patient's condition.
Diagnosis of subcapsular hemorrhages is rather difficult: with such lesions, the condition of the patients is satisfactory for the first few days, after which it sharply worsens.
Diagnosis of the patient may be made difficult by alcoholic intoxication of the patient or an unconscious state caused by traumatic brain injury.
Therapeutic measures
Many are interested in how liver rupture is treated and whether a conservative treatment of this pathology is possible. Rupture treatment can only be carried out operatively. In no case can you pull: if you ignore the rupture of the liver, the consequences can be fatal. Therapy consists in stopping bleeding, removing accumulated blood in the abdominal cavity and necrotic tissue. The operation must be carried out as quickly as possible: every hour of delay increases the likelihood of death. The refusal from the operation is justified only if the victim was hospitalized in a serious inoperable condition.
Prognosis for liver rupture
If the patient has a liver rupture, the prognosis depends on a number of factors:
- degree of damage to the organ;
- the nature of the injury;
- patient age: children and elderly people suffer liver ruptures much harder than other categories of patients;
- timeliness of surgical intervention.
What could be the complications?
One of the most serious complications that can be accompanied by rupture of the liver is hemobilia. In hemobilia, blood from vessels destroyed as a result of an injury begins to accumulate around the duct of the gallbladder and enters from the biliary tract. Hemobilia can be eliminated only by eliminating the message between the vessel and the gallbladder. Otherwise, the patient may die due to extensive blood loss.
A rarer complication is biligemia. This condition develops if both the bile ducts and large vessels are affected. In this case, blood can enter the bile. Such conditions are treated only by surgery.
Often due to improperly performed surgical intervention, prolonged bleeding occurs through drainage or directly into the abdominal cavity. Typically, such bleeding is detected several days after surgery. In addition, some patients develop subphrenic abscesses, liver cysts, or postoperative fistulas.
The death of victims of a liver rupture in most cases is caused by an impressive amount of lost blood. The number of deaths in the intraoperative period is about 9%. If the patient has damage to other organs, then the mortality rate increases significantly (up to 24%).
Liver rupture, the causes of which can be quite diverse, is a dangerous condition that requires immediate medical attention. Otherwise, there is a high risk of death due to severe blood loss that accompanies this type of injury.