Injuries to the abdominal organs are one of the most severe varieties, since in most cases they pose a threat to the life of the victims. The causes of such injuries can be road accidents, blows to the abdomen or a fall from an impressive height. In this case, ruptures of the liver most often occur, which is associated with a rather large size and structure of this organ. What is a liver rupture, how to provide assistance to the victims and how will the treatment proceed in a medical institution? You will find out the answer by reading this article.
Structure of the liver
Before proceeding to the characteristics of liver damage, it is worth saying a few words about the structure of this organ. What is the liver, where is it located and how does this organ 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: an upper one, located directly below the diaphragm, and a lower one.
The liver consists of two lobes: right and left. The lobes are separated from each other by a falciform ligament. Adjacent to the liver is the gallbladder, which is a reservoir for the bile secreted by the organ.
Liver Functions
The liver performs a number of important functions. It purifies the blood, reproduces various proteins necessary for the 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. At the same time, 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 any disease in time, the treatment will bring much better results.
Traumatic tears
The liver has a fairly dense texture, 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, when injured or hit, the fabric can tear quite easily.
The liver can be damaged by injuries to the chest or lower back. It is not uncommon for a liver to rupture in an accident. A severe blow to the liver can provoke injury. This is due to the specifics of the anatomical location of the organ, as well as its impressive weight. Since the liver does not differ in elasticity 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 happens extremelyrare.
Is it possible spontaneous liver rupture?
The risk of liver rupture is high if 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 ruptures of the liver can be observed in the presence of malignant neoplasms in this organ or in vascular aneurysms.
Rupture of the liver can happen during pregnancy. This pathology has been described about 120 times since 1844. However, most of the 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;
- parenchymal rupture in which bleeding quickly stops after the surgeon applies stitches;
- deep ruptures, in which 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 quite quickly due to blood loss.
There are also biphasic or delayed liver ruptures. With such injuries, a subcapsular or intrahepatic hematoma is formed, which subsequently breaks into the abdominal cavity.
If a liver rupture is accompanied by a violation of the integrity of the fibrous membrane of the organ, then the blood entersabdominal cavity. If there is damage to the diaphragm, then blood is found in the pleural cavity. If the fibrous membrane is not damaged, then the blood gradually accumulates between it and the parenchyma.
What threatens a ruptured liver?
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 should be noted that the parenchyma and vessels of the liver are not capable of contraction. This causes the development of bleeding that cannot stop spontaneously. Also, blood loss increases due to the fact that the liver is constantly moving during breathing. In addition, bile is mixed with the blood, which greatly complicates its clotting. In rare cases, bleeding may stop without medical intervention. As a rule, this occurs in cases where large vessels have not been destroyed.
Symptomatics
The main symptoms of liver rupture include:
- Pain in the abdomen. The pain can be both barely perceptible and sharp. Often, with liver damage, the victim takes a forced sitting position: when trying to change the position, the pain becomes more intense (roly-up syndrome).
- The pain becomes stronger if the victim rolls over to the left side: this is due to the fact that the blood accumulated in the right side of the abdomen moves to the left side.
- The victim's lips may turn blue.
- After an injury, the abdomen is tense andretracted.
- Nausea and vomiting.
- The appearance of cold sweat, cooling of the limbs.
- The victim may feel very thirsty.
- Pale skin.
- Loss of consciousness, pain shock.
If the hematoma is small when the liver ruptures, 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 is slightly enlarged. There may be a rise in temperature, sometimes a slight jaundice develops. In the future, with any slight tension, a rupture of the capsule may occur, while the hematoma is poured into the abdominal cavity.
Immediately after an injury, the pressure rises, but as bleeding increases, 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?
Diagnosing a liver rupture can present certain difficulties, especially if the patient has received other injuries. If a liver rupture is not diagnosed in time, the consequences can be very serious. Fortunately, thanks to modern diagnostic methods, errors are minimized.
Recently, a puncture of the abdomen with the introduction of a special catheter has been used to diagnose liver ruptures. Thanks to this method, it is possiblepromptly identify the specifics of the injury and take the necessary therapeutic measures. For some patients, an ultrasound of the liver is recommended to make a correct diagnosis.
To determine the intensity of changes caused by blood loss, a blood test helps. The number of red blood cells begins to decline a couple of hours after the rupture has occurred, subsequently developing acute anemia. 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 quite difficult: with such lesions, the condition of the patients is satisfactory for the first few days, after which it deteriorates sharply.
Diagnosis can be difficult if the patient is intoxicated or unconscious due to traumatic brain injury.
Therapeutic interventions
Many are interested in how liver rupture is treated and whether conservative treatment of this pathology is possible. The rupture can only be treated with surgery. In no case should you pull: if you ignore the rupture of the liver, the consequences can be fatal. Therapy consists in stopping bleeding, removing blood accumulated in the abdominal cavity and necrotic tissues. The operation must be carried out as quickly as possible: every hour of delay increases the likelihood of death. Refusal to operate is justified only if the victimwas admitted to the hospital in a serious inoperable condition.
Prognosis for liver rupture
If a patient has a liver rupture, the prognosis depends on a number of factors:
- degree of organ damage;
- nature of injury;
- age of the patient: children and the elderly suffer from liver ruptures much harder than other categories of patients;
- timeliness of surgical intervention.
What are the complications?
One of the most serious complications that can accompany liver rupture is hemobilia. With hemobilia, blood from the vessels destroyed as a result of injury begins to accumulate around the gallbladder duct and enters the bile ducts. Hemobilia can be eliminated only by eliminating the communication between the vessel and the gallbladder. Otherwise, the patient may die due to extensive blood loss.
A more rare complication is bilemia. This condition develops if both the bile ducts and large vessels are simultaneously affected. In this case, blood can flow into the bile. Such conditions are treated only by surgery.
Often due to incorrectly performed surgical intervention, prolonged bleeding occurs through the drainage or directly into the abdominal cavity. Usually such bleeding is found several days after the operation. In addition, some patients develop subdiaphragmatic abscesses, liver cysts, or postoperative fistulas.
The death of the victimsin rupture of the liver in most cases is caused by an impressive amount of blood lost. 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%).
Rupture of the liver, 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.
