Hepatic Hematoma: Management & Treatment

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

Blood constantly passes through your liver. If your liver is injured, it can result in a hepatic hematoma. In this lesson, we will learn more about hepatic hematomas and how to treat them.

What is the Liver?

Your liver is located in the upper right side of your abdomen. The liver is surrounded by a capsule which is made up of connective tissue. The parenchyma of the liver is made up of cells that filter your blood. It is protected by your ribs and is one of the biggest organs in your body! It is also one of the most injured organs in abdominal injuries.


liver


Your liver is the filter for your body. Blood passes through the liver and toxins are removed. Without a healthy liver, your body would fill up with toxins. Therefore, you can't live without a functioning liver.

The liver has many other important roles as well. It produces bile, which helps with digestion. It plays a role in the metabolism of fats, carbohydrates, and proteins. The liver metabolizes medications so our body can use them. It also stores glucose and plays a role in blood clotting.

You may take your liver for granted, but hopefully, you understand how important it is!

Hepatic Hematoma

As stated earlier, the liver is a very large organ, which probably contributes to it being one of the most injured organs in abdominal injuries. Since blood is being filtered through the liver, an injury to the liver can result in bleeding which can be significant and life-threatening.

One type of liver injury is a hepatic hematoma. Hepatic refers to the liver, and hematoma means a collection of blood outside of the blood vessels. A liver injury could result in a hemorrhage, which refers to active bleeding. Conversely, a hepatic hematoma is an injury in which there was bleeding, but it has essentially clotted. There isn't active bleeding, and the blood is collected in a sealed area.

Causes

Causes of hepatic hematoma are often from a blunt force injury. Sometimes, it is the result of a direct impact to the area of the liver, such as from a car accident. Hepatic hematomas also occur in obstetrical patients with certain complications. Liver biopsies and bleeding disorders have also resulted in hepatic hematomas.

Symptoms

Symptoms associated with hepatic hematomas include abdominal discomfort and pain. The nerves in the area of the liver extend to the right shoulder, so pain may be felt in the right shoulder as well. The liver is close to the stomach, so other symptoms include nausea and vomiting.

Treatment of Hepatic Hematoma

Many years ago, virtually all liver injuries underwent surgery. In current practice, the majority of liver injuries are managed without surgery. Physicians use the American Association of Surgery for Trauma (AAST) scale to help grade the severity of liver injuries and determine the need for surgery.

The first four grades on the AAST scale refer to hepatic hematomas.

  1. Grade I- Subcapsular hematoma <10cm surface area
  2. Grade II- Subcapsular hematoma 10-50% surface area; Intraparenchymal <10cm diameter
  3. Grade III- Subcapsular hematoma >50%; Ruptured subcapsular hematoma with active bleeding; Intraparenchymal hematoma >10cm
  4. Ruptured intraparenchymal hematoma with active bleeding

Imaging tests, such as a CT scan or MRI, will be done to visualize the liver and determine the extent of the bleeding. This allows the physician to grade the liver injury. Liver injuries Grade I-III are managed nonoperatively-- as long as there are no other injuries, and the patient is stable. Liver injuries Grade IV and above require surgery to manage.

Nonoperative management of Hepatic Hematoma

If the patient is stable and has a Grade III or lesser injury, the physician will choose nonoperative management of the liver injury. This involves administering intravenous fluids and blood transfusions. The patient will be closely monitored to evaluate for further bleeding and assess healing progression.

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