A liver injury can be sustained through blunt (motor vehicle accident) or penetrating (knife or gunshot) trauma. Due to the location and high vascularity of the liver, it is vulnerable to injury and serious consequences such as hemorrhage.
The large and highly vascular liver is located in the right upper quadrant, which is underneath the diaphragm. Hence the position of the liver renders it susceptible to shear forces . Moreover, it is the most frequently harmed organ in blunt abdominal trauma and second most commonly affected organ in penetrating mechanisms .
The clinical presentation of patients with liver injury consists of abdominal and right chest wall pain and referred pain to the right shoulder. Also, the patient will very likely exhibit peritoneal signs. Mental status changes may occur as well.
Among the serious outcomes that develop in a considerable number of people with liver trauma is delayed hemorrhage, hepatic or perihepatic abscess, bile duct injury leading to the formation of biloma, and abdominal compartment syndrome  .
The vital signs may point to hemodynamic instability and hemorrhagic shock. Other remarkable findings include abdominal and chest wall tenderness along with abdominal distension. Additionally, hematomas may be notable.
The clinician must perform a thorough physical exam investigating all possible injuries since the vast majority of patients will have additional trauma. Specifically, the chest and spleen are the most commonly involved accompanying a liver injury . Blunt trauma can also cause rib and pelvic fractures and spinal cord injuries.
In order to understand the extent of the damage, the trauma team should inquire about how the patient acquired the injury. Other crucial components of the workup include a thorough physical exam and imaging studies. Moreover, newer innovations in imaging techniques have not only improved the diagnostic accuracy, these also paved the way for conservative management.
In hemodynamically stable patients with blunt abdominal trauma, computed tomography (CT) is the imaging modality of choice  . The CT scan will provide information about the abdominal and retroperitoneal structures, the severity of hemoperitoneum, and other complications . This imaging test demonstrates up to 97% sensitivity and nearly 99% specificity for liver injuries . Furthermore, CT scanning is significant in the nonsurgical management of patients with liver injury as experts advocate for follow-up studies to assess the presence of delayed complications and resolution .
The focused assessment with sonography for trauma (FAST) test is used as a rapid bedside evaluation to identify the presence of hemoperitoneum . Both the sensitivity and specificity of FAST may reach up to 100% . Contrast-enhanced ultrasonography can improve evaluation of blunt trauma  as non-contrast sonography may fail to detect the presence of blood or injuries to intraabdominal and retroperitoneal organs.
Angiography assists in the detection of active bleeding sites, which can be treated with angioembolization.
Magnetic resonance cholangiopancreatography (MRCP) is useful for evaluation of bile duct injuries .
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