liver trauma

2. INTRODUCTION
• The liver is the largest solid abdominal organ
with a relatively fixed position, which makes it
prone to injury. The liver is the second most
commonly injured organ in abdominal trauma,
but damage to the liver is the most common
cause of death after abdominal injury.

3. DEFINITION
• Liver trauma is caused by landing, or being hit,
on the right chest or upper abdomen.

4. CAUSES
• Blunt (nonpenetrating) abdominal injuries
usually result from motor vehicle accidents,
fights, falls from heights, and sports accidents.
• Penetrating abdominal injuries usually result
from stabbings and gunshots.

5. PATHOPYSIOLOGY
The liver is also vulnerable to penetrating trauma.
Liver injuries present a serious risk for shock because the liver tissue is
delicate and has a large blood supply and capacity.
Liver may be lacerated or contused, and a hematoma may develop.
It may leak bile, usually without serious consequences.
If severely injured, the liver may cause exsanguination(bleeding to death).

6. SIGN AND SYMPTOM
• In blunt trauma, there will often be fractures of
the 7-9th ribs overlying the liver make it feel
pain.
• Right upper quadrant tenderness will be
present.

7. DIAGNOSTIC TEST
1. If the patient is stable,CT scan of the abdomen may
demonstrate a laceration that can be managed non-
operatively. Suspect liver laceration when penetrating
trauma involves the right lower chest or right upper
abdomen, or when right upper quadrant tenderness
accompanies blunt trauma.
2.If the patient is in shock, or has urgent injuries, perform
peritoneal lavage to confirm intraperitoneal
hemorrhage. Finding bile on peritoneal lavage means
biliary tract injury.

8. TREATMENT
• Large lacerations and gunshot injuries require
laparotomy and repair. Many small
lacerations can be followed conservatively.

9. COMPLICATION
• Severe liver injuries often lead to
exsanguination, which is the most common
cause of death.
• Hemorrhage and hypovolemic shock. Later
complications include infection and
dysfunction of organs.

10. NURSING CARE PLAN 1
Nursing diagnosis:
• Acute or chronic pain related to injuring organ.
Goal:
• The client level of pain will controlled.

11. CON’T…
NURSING INTERVENTION
1. Investigate changes in frequency or description of pain.
Rationale: May signal worsening of condition or development of
complications.
2. Monitor heart rate, BP using correctly sized cuff, and respiratory
rate, noting age appropriate normals and variations.
Rationale: Changes in autonomic responses may indicate increased
pain.
3. Administer medications, such as opioid and nonsteroidal
analgesics, as indicated.
Rationale: pain management may be needed to overcome or control
pain.

12. NURSING CARE PLAN 2
Nursing diagnosis:
• Anxiety related to anticipated loss of
physiological well-being, change in body
function perceived death of client .
Goal:
• Client will more understanding to the situation.

13. CON’T…
NURSING INTERVENTION
1.Inform client about planning to do and why. Include client in planning
process and provide choices when possible.
Rationale: Enhances sense of trust, and explanation may increase
cooperation and reduce anxiety. Provides sense of control over self in
circumstance where loss of control is a significant factor. Note: Feelings of
self-worth are intensified when one is treated as a worthwhile person.
2. Reorient frequently.
Rationale: Client may experience periods of confusion, resulting in
increased anxiety.
3. Administer medications, as indicated, for example: Benzodiazepines,
such as chlordiazepoxide (Librium), and diazepam (Valium)
Rationale: Anti-anxiety agents are given during acute withdrawal to help
client relax, be less hyperactive, and feel more in control.