Rupture of the liver: causes, treatment, consequences, prognosis

Injuries to the abdominal organs are one of the hardest varieties, because in most cases they represent a threat to the lives of the victims. The causes of such damage can be road accidents, blows to the abdomen or drop from an impressive height. In this case, most often there are liver ruptures, which is due to the fairly large size and structure of this organ. What is a liver rupture, how to provide assistance to the injured and how will the treatment proceed in a medical institution? You will find out the answer after reading this article.

The 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 this organ and how does it hurt? The liver is located in the upper part of the peritoneum, occupying the right hypochondrium. The weight of the liver of an adult reaches an average of one and a half kilograms. The organ has two surfaces: the upper surface, located directly below the diaphragm, and the lower one.

The liver consists of two parts: the right and left. The shares are separated from each other by a crescent ligament. The gallbladder adjoins the liver, which is the reservoir for the bile secreted by the body.

Functions of the liver

The liver performs a number of important functions. It purifies the blood, reproduces the various proteins necessary for the normal functioning of the body, produces enzymes and takes part in all kinds of metabolism. During the intrauterine development of a person, the liver performs hematopoietic functions. However, many people know very little about it, for example, the liver where it is and how this organ hurts. These knowledge are very important: if you suspect a disease in time, the treatment will bring much better results.

Traumatic ruptures

The liver has a fairly dense consistency, however 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). A thin peritoneum does not promote 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, tissue can burst quite easily.

The liver can be damaged by trauma to the chest or lower back. It is not uncommon for the liver to break during an accident. Provoke a trauma can be a severe blow to the liver. This is due to the specific nature 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 often enough.

In some cases, a cardiac-pulmonary resuscitation may lead to liver ruptures, but this happens very rarely.

Is spontaneous rupture of the liver possible?

The risk of liver rupture is great if the organ is affected by some disease. With malaria, syphilis, amyloidosis, even weak external influences can lead to rupture. Such damage can cause not only a blow to the liver, but also muscle strain of the press, for example, when coughing. Spontaneous liver ruptures can be observed in the presence of malignant neoplasms in this organ or in vascular aneurysms.

Rupture of the liver can happen on a background of pregnancy. This pathology has been described about 120 times since 1844. In this case, most women have been diagnosed with hypertension.

Classification of liver ruptures

In terms of severity, these injuries are divided into 4 main categories:

• Violation of the integrity of the capsule with a slight bleeding;
• Rupture of the parenchyma, in which the bleeding ceases quickly after the surgeon sutures;
• Deep gaps in which shock and loss of consciousness are observed in the affected;
• Rupture of the parenchyma, accompanied by a violation of the integrity of large vessels - with such trauma, a person can quickly die due to blood loss.

There are also two-phase, or delayed laceration of the liver. With such damage, subcapsulated or intrahepatic hematoma forms, which subsequently breaks through into the abdominal cavity.

If the rupture of the liver is accompanied by a violation of the integrity of the fibrous membrane of the organ, the blood enters the abdominal cavity. In case there are damages to the diaphragm, the blood is found in the cavity of the pleura. If the fibrous membrane is not damaged, the blood gradually accumulates between it and the parenchyma.

What threatens the rupture of the liver?

Liver ruptures almost always represent 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 blood vessels of the liver are not capable of contraction. This causes the development of bleeding, which can not stop spontaneously. Loss of blood also increases due to the fact that the liver constantly moves with breathing. In addition, bile is mixed with the blood, which greatly complicates its coagulation. In rare cases, bleeding can stop without medical intervention. Typically, this occurs in cases where large vessels have not been destroyed.

Symptomatics

The main symptoms of liver rupture are:

• Pain in the abdomen. The pain can be either barely perceptible or sharp. Often, with injuries of the liver, the victim takes 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 the blood accumulated in the right side of the abdomen moves to the left side.
• The lips of the victim can turn blue.
• After receiving the injury, the stomach is tense and drawn.
• Nausea and vomiting.
• The appearance of cold sweat, cooling of limbs.
• The victim can feel a strong thirst.
• Pale skin.
• Loss of consciousness, painful shock.

If the hematoma is small with a liver rupture, the patient's condition is usually satisfactory. If the damage is more significant, then the patients are in serious condition. With minor injury in the first days after its reception, symptoms are absent. Usually the pain comes to naught in a couple of days, but the liver slightly increases. There may be a rise in temperature, sometimes a slight jaundice develops. In the future, at any insignificant stress, the capsule can rupture, with the hematoma poured into the abdominal cavity.

Immediately after the injury is received, the pressure rises, but after an increase in the bleeding, it begins to decrease. It is believed that the pressure drop begins after the volume of blood loss reaches 800-1500 milliliters.

How is the liver rupture diagnosed?

Diagnosis of liver rupture may present certain difficulties, especially if the patient has received other injuries. If you do not diagnose "liver rupture" in time, the consequences can be very serious. Fortunately, due to modern methods of diagnosis, errors are minimized.

Recently, for the diagnosis of liver ruptures, abdominal puncture is used with the introduction of a special catheter. Thanks to this method, it is possible to quickly identify the specificity of the trauma and to carry out the necessary medical measures. Some patients are recommended to make ultrasound of the liver for the diagnosis.

To determine the intensity of the changes caused by blood loss, a blood test helps. The number of red blood cells begins to decrease a couple of hours after the rupture, then develops 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 monitor the dynamics of the patient's condition.

Difficulty diagnosed with subcapsular hemorrhages: with such lesions for the first few days, the condition of the patients is satisfactory, after which it deteriorates sharply.

Diagnosis may be difficult to alcoholic intoxication of the patient or unconscious condition caused by head injury.

Therapeutic events

Many people are interested in the treatment of liver rupture and whether conservative treatment of this pathology is possible. Treatment of the rupture can be carried out only in an operative way. Pull in any case impossible: if you ignore the rupture of the liver, the consequences can be lethal. Therapy consists in stopping bleeding, removing accumulated blood in the abdominal cavity and necrotic tissues. The operation should be carried out as quickly as possible: every hour of delay increases the likelihood of death. The refusal of the operation is justified only if the victim has entered the hospital in a severe unoperable condition.

Prognosis for liver rupture

If the patient has a liver rupture, the prognosis depends on a number of factors:

• Degree of organ damage;
• The nature of the injury;
• The age of the patient: children and elderly people suffer liver ruptures much heavier than other categories of patients;
• Timeliness of the surgical intervention.

What can be complications?

One of the most serious complications that can be accompanied by a liver rupture is hemobiology. With hemobiology, the blood from the vessels that have been destroyed as a result of the trauma starts to accumulate around the duct of the gallbladder and comes from the biliary tract. Hemobiology can be eliminated only by eliminating the communication between the vessel and gallbladder. Otherwise, the patient may die due to extensive blood loss.

A more rare complication is biligemia. This condition develops if both bile ducts and large vessels are simultaneously affected. In this case, the blood can enter bile. Such conditions are treated only in an operative way.

Often because of improperly performed surgery, there is a prolonged bleeding through the drainage or directly into the abdominal cavity. Usually, such bleeding is detected several days after the operation. In addition, in some patients sub-diaphragmatic abscesses, liver cysts or post-operative fistulas are formed.

The death of those affected by liver rupture is in most cases caused by an impressive volume of lost blood. The number of deaths in the intraoperative period is about 9%. If the patient has damage to other organs, then the level of lethality significantly increases (up to 24%).

The rupture of the liver, the causes of which can be quite diverse, is a dangerous condition requiring immediate medical intervention. Otherwise, the risk of a fatal outcome is high due to the severe blood loss accompanying this type of injury.