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 [1]. Moreover, it is the most frequently harmed organ in blunt abdominal trauma and second most commonly affected organ in penetrating mechanisms [2].

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.

Complications

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 [3] [4].

Physical exam

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 [5]. Blunt trauma can also cause rib and pelvic fractures and spinal cord injuries.

• Congestive Heart Failure

  Multivariable logistic regression was used to evaluate the risks of acute liver injury and death in patients with baseline liver disease, congestive heart failure, malnutrition, and HIV. [ncbi.nlm.nih.gov]

  Labeling in Canada, however, clearly warns of CoQ10 depletion and even notes that this nutrient deficiency "could lead to impaired cardiac function in patients with borderline congestive heart failure ." [articles.mercola.com]

• Overeating

  A 36-year-old Japanese woman took over-the-counter (OTC) medication for headaches for 20 days. [ncbi.nlm.nih.gov]

  For some vulnerable segments of the population, such as children, taking slightly more than the therapeutic dose over long periods can also result in overdoses, he said. [cbc.ca]

  Discerning when and where these signals begin and how they propagate over time is very challenging with existing cell culture and analysis tools. [pubs.rsc.org]

• Abdominal Pain

  Liver function tests should be performed when there is upper abdominal pain after administration of clomiphene citrate. [ncbi.nlm.nih.gov]

• Diarrhea

  Early symptoms include: Nausea Loss of appetite Fatigue Diarrhea However, as liver failure progresses, the symptoms become more serious, requiring urgent care. [webmd.com]

  However, lactulose can have side effects, including nausea, gas, abdominal cramps and diarrhea. Due to these side effects some patients may not be able to tolerate lactulose over the long-term. [catie.ca]

  Diarrhea. White stools. Rash. Build-up of fluid in the abdominal cavity. Jaundice (yellowing of eyes and skin). Enlarged liver. Fatigue. Weight loss. Loss of appetite. [drugabuse.com]

• Right Upper Quadrant Tenderness

  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 [slideshare.net]

• Heart Failure

  Multivariable logistic regression was used to evaluate the risks of acute liver injury and death in patients with baseline liver disease, congestive heart failure, malnutrition, and HIV. [ncbi.nlm.nih.gov]

  If [cholesterol sulfate is not produced]... you end up with heart failure." See Dr. [articles.mercola.com]

  Patients with other diagnoses (cancer, gallbladder disease, pancreatic disease, heart failure, alcohol abuse/liver damage/toxic effects, HIV infection, rheumatoid arthritis, sarcoidosis, systemic lupus, viral hepatitis, sclerosing cholangitis, chronic [phekb.org]

  Heart failure. Liver disease. [drugabuse.com]

• Vascular Disease

  Often the cause of a drug-induced liver disease is quite apparent to physicians, but in some cases, other causes for liver disease, such as hepatitis, cancer, metabolic disease, or vascular disease, may need to be ruled out first. [verywellhealth.com]

  Hepatic hemorrhage may occur as a result of causes other than trauma, including sickle cell anemia, liver tumors, coagulopathies, organ phosphate toxicity, and collagen vascular disease. [emedicine.medscape.com]

• Liver Dysfunction

  The patient's liver biopsy showed chronic active hepatitis and autoimmune hepatitis. Stopping the use of these drugs did not lead to complete remission, but the use of a low dose of corticosteroids completely cured his liver dysfunction. [ncbi.nlm.nih.gov]

• Hepatomegaly

  Physical examination shows hepatomegaly without splenomegaly. GH is diagnosed by biopsy as it is clinically indistinguishable from non-alcoholic fatty liver disease (NAFLD), a more common cause of hepatic dysfunction in diabetics. [ncbi.nlm.nih.gov]

  Budd–Chiari syndrome may sometimes mimic DILI, and thus it should be considered, especially if tender hepatomegaly and/or ascites are evident. [gi.org]

• Kidney Failure

  The pressure or retained urine can back up all the way to the kidneys, resulting in kidney failure or even heart attack. At the same time, toxins build up in the blood, causing confusion and headaches. [narconon.org]

  Statin drugs cause liver damage, kidney failure and cataracts, says BMJ 11/7/2010 - Cholesterol-lowering statin drugs significantly increase a person's risk of cataracts, muscle weakness, liver dysfunction and kidney failure, according to a study in the [naturalnews.com]

  Life-threatening complications of ARLD include: internal (variceal) bleeding build-up of toxins in the brain (encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer increased vulnerability to infection [nhs.uk]

  They may include liver related conditions that are a consequence of portal hypertension: build up of fluid in the abdomen bleeding from veins in the esophagus or stomach enlarged spleen brain disorders and coma kidney failure liver cancer In addition [liverfoundation.org]

  NSAIDs are safe when used properly and as prescribed by doctors; however, patients with cirrhosis and advanced liver disease should avoid NSAIDs since they can worsen liver function (and cause kidney failure as well). [medicinenet.com]

• Renal Insufficiency

  Transplant recipients with long-term survival have the highest risk for anesthesia because of post-transplant complications, including diabetes, hypertension, and renal insufficiency. [ncbi.nlm.nih.gov]

  Patients with ALF due to DILI are more likely to develop ascites, infection, and renal insufficiency as preterminal complications. [gi.org]

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.

Imaging

In hemodynamically stable patients with blunt abdominal trauma, computed tomography (CT) is the imaging modality of choice [6] [7]. The CT scan will provide information about the abdominal and retroperitoneal structures, the severity of hemoperitoneum, and other complications [8]. This imaging test demonstrates up to 97% sensitivity and nearly 99% specificity for liver injuries [9]. 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 [4].

The focused assessment with sonography for trauma (FAST) test is used as a rapid bedside evaluation to identify the presence of hemoperitoneum [10]. Both the sensitivity and specificity of FAST may reach up to 100% [10]. Contrast-enhanced ultrasonography can improve evaluation of blunt trauma [11] 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 [12].

Diagnostic peritoneal lavage was previously utilized for diagnosis of blunt trauma [13], but CT and FAST are preferred.

• Hypoalbuminemia

  He also had abnormal liver function tests, including hypoalbuminemia. Laboratory tests were consistent with HI, which responded to diazoxide treatment (10 mg/kg/day started at 10 days of age). [ncbi.nlm.nih.gov]

Liver injury fully improved after initiation of corticosteroid for the treatment of adrenal insufficiency. [ncbi.nlm.nih.gov]

CONCLUSIONS: Our work summarises current knowledge regarding clinical presentation, disease course, and prognosis of TCM-ILI. TCM can result in hepatotoxicity, even death or necessitate life-saving liver transplantation. [ncbi.nlm.nih.gov]

In addition, improved prognosis of patient outcome or accelerated identification of the underlying etiology may be facilitated by more detailed knowledge of effectors and targets related to acute liver failure. [journal.frontiersin.org]

Prognosis was mainly correlated with the interval between trauma and surgical treatment as well as with the… CONTINUE READING [semanticscholar.org]

Conclusion Acquired liver injury and hepatotoxicity occur frequently in critically ill patients and affect prognosis. The main causes of acquired liver injury include shock, sepsis, drugs, and parenteral nutrition. [anesthesiology.pubs.asahq.org]

This implies an immune-mediated etiology of DILI, especially ciprofloxacin-induced cholestatic liver injury. DILI is challenging to diagnose in the setting of multiple comorbidities. [ncbi.nlm.nih.gov]

New approaches for the treatment of certain etiologies and of acute liver failure in general could be derived from molecular targets or mechanisms involved in these processes. [journal.frontiersin.org]

Organizations of Medical Sciences (CIOMS), the Roussel Uclaf Causality Assessment Method (RUCAM) is the most used causality assessment tool worldwide for the diagnosis of drug-induced liver injury (DILI) and herb-induced liver injury (HILI) in a large number of epidemiological [ncbi.nlm.nih.gov]

Ruth Brauer, research student, Liam Smeeth, professor of clinical epidemiology 1 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK Correspondence to: I Douglas ian.douglas{at}lshtm.ac.uk [bmj.com]

Shock 2009; 32:358–65 Larrey D: Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. [anesthesiology.pubs.asahq.org]

HDS induced liver injury Epidemiology HDS hepatotoxicity has received increasing attention over the past few years, in part owing to the recognition in the United States that among DILI cases HDS are the second most common cause ( 16 ). [gi.org]

In this review, we will discuss the pathophysiological mechanisms underlying DILI. [ncbi.nlm.nih.gov]

Rowan van Golen studies a number of pathophysiological aspects of this type of injury, and the interaction between parenchymal liver pathology and surgery-induced liver injury. R.F. van Golen: A Treatment Rationale for Surgery-Induced Liver Injury. [uva.nl]

"Acetaminophen (paracetamol) poisoning in adults: Pathophysiology, presentation, and diagnosis." UptoDate.com. Updated Oct. 6, 2015. [medicinenet.com]

OA scavenged ROS, prevented oxidative damage and maintained the normal structure of mitochondria. We further confirmed that OA increased adenosine triphosphate (ATP) by promoting the TCA production cycle and oxidative phosphorylation (OXPHOS). [ncbi.nlm.nih.gov]

[…] committed to preventing and curing liver disease. [aasld.org]

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