Liver rupture - how dangerous is it?
introduction
A tear in the liver (Liver rupture) is usually caused by a blunt abdominal trauma such as a punch in the stomach or an inconvenient fall.
A liver rupture often occurs as part of an accident or a sports injury. This mainly affects martial artists who suffer severe abdominal injuries from blows or kicks, or equestrians who can tear the liver from kicks or falls.
Also traffic accidents can lead to a rupture of the liver through various mechanisms. For example, when a broken rib injures the liver. Depending on how the crack runs in the liver and which blood vessels are injured, it happens life threatening bleeding in the abdomen, which must be surgically breastfed.
If the liver capsule is also torn, so can Bile and blood into the free abdominal cavity which can result in a loss of several liters of blood. It can also be dangerous due to the blood and bile in the abdominal cavity Peritonitis (Peritonitis) come.
In most cases, the liver tear is one emergencythat should be operated on immediately.
Is a ruptured liver dangerous?
A liver tear is a very serious injury that is life-threatening and in the worst case scenario can lead to death. On the one hand, internal bleeding can lead to blood loss that is so pronounced that it leads to circulatory failure and cardiac arrest. On the other hand, peritonitis can develop, which can also be fatal.
It is therefore extremely important to call an emergency doctor as soon as possible if you experience symptoms such as upper abdominal pain, cold sweat or palpitations after an abdominal injury. By initiating emergency medical measures in good time, the patient's condition can often be stabilized and transport to a hospital for an emergency operation can be made possible. In the case of a very pronounced rupture of the liver and other diseases, however, it may also be that rescue is no longer possible and the injury is fatal.
Signs of a ruptured liver
Signs of a liver rupture usually show up very quickly after a triggering event that led to the organ injury, such as an accident. Typical symptoms include pain in the upper abdomen and abdominal cramps. Pronounced internal bleeding can also lead to a drop in blood pressure and, as a result, circulatory problems up to fainting and even cardiac arrest. After a liver rupture, in which the capsule of the organ was also destroyed, the escape of bile into the abdominal cavity can lead to peritonitis. Signs of this are severe pain all over the abdomen and a tight abdominal wall as hard as a board. Other possible accompanying signs of a ruptured liver are dizziness, cold sweating, racing heart and feelings of fear. However, these are unspecific complaints that can also have other causes (for example a heart attack).
Whether there is a rupture of the liver or the symptoms have another cause can only be found out through a medical diagnosis. These include a physical exam and an ultrasound of the abdomen.
causes
In the vast majority of cases, patients with a ruptured liver report a previous one trauma in form of Accident or one Sports injury.
The most common cause here is a dull abdominal traumacaused by a blow or kick in the right upper abdomen. This occurs more frequently in some sports such as martial arts or equestrian sports.
Also unfavorable falls Rupture of the liver can be the cause of a tear in the liver from a great height or on hard objects.
Furthermore are traffic accidents a common cause of such abdominal trauma.
Are less common than blunt abdominal injuries sharp trauma how Knife wounds or an injury from broken ribs.
A rupture of the liver can very rarely during pregnancy as part of the so-called HELLP syndrome occur.
HELLP syndrome is a serious illness during pregnancy in which, among other things, to increased tendency to bleed and one Increase in liver values comes. If there is bleeding into the liver capsule, a liver tear can be a rare but dreaded complication.
Can the liver tear from coughing?
The liver cannot rupture from coughing. It is possible that a very strong or prolonged cough may cause pain in the area where the liver is located. However, these are usually triggered by irritation of the lungs (pleurisy) from the cough and there is no risk of a liver tear. Even with a pre-existing liver, a rupture of the organ cannot be caused by coughing. In the case of Pfeiffer's glandular fever (infectious mononucleosis), the liver can swell and, in very rare cases, a rupture of the organ, but only as a result of greater force such as a blow and shock. Coughing cannot cause a rupture of the liver even in such an adverse situation.
What role does alcohol play in a ruptured liver?
Regular alcohol consumption generally has a damaging effect on the liver. A ruptured liver is not a typical direct result of alcohol, however. In most cases, the trigger is an act of violence, such as in a traffic accident. A liver damaged by alcohol can at most increase the risk that the organ will rupture in the event of violence. Frequent alcohol consumption can initially lead to fatty degeneration of the liver and then over time to connective tissue scarring of the organ (liver fibrosis), which is ultimately associated with a loss of liver function. The result is, among other things, blood clotting disorders, disorders of consciousness and thinking, as well as ascites. In addition, alcohol increases the risk of developing liver cancer. Even a daily consumption of half a liter of beer or two glasses of wine can damage the liver in the long term. If alcohol is not consumed daily and in too large quantities, the liver is usually better able to regenerate.
Symptoms
Because a rupture of the liver is not spontaneous, but in most cases traumatic people often report an incident such as a blow in the stomach or an accident. This accident, the hemorrhage and the rupture of the liver capsule also lead to some severe upper abdominal pain on the right.
If it bleeds heavily into the abdominal cavity, it can lead to a swelling coming and going in the abdomen Bruising. If the blood in the free abdominal cavity causes peritonitis, severe pain and a board-hard abdominal wall are the result.
Due to the loss of blood into the abdominal cavity, which sometimes occurs when larger vessels are torn. can be several liters, it comes to Drop in blood pressure and Circulatory weakness up to unconsciousness and one Cardiovascular arrest due to the insufficient supply of vital organs such as the heart and brain.
So if there is severe upper abdominal pain, bruises or dizziness and weakness after an abdominal trauma, a doctor should be consulted immediately.
Based on the narrative and the patient's condition, the latter already has a suspicion that he is dealing with a Ultrasound examination of the abdomen can quickly confirm.
In this way it can also be assessed how quickly there is a need for action and, for example, whether an immediate emergency operation is indicated.
Pain in a ruptured liver
With a ruptured liver, there is typically severe pain. These are usually felt in the upper right abdomen and can also be convulsive. In some cases the pain is localized deeper in the lower abdomen or higher in the chest area. In the case of a ruptured liver, the symptoms are usually directly related to a triggering event that led to the damage to the organ, such as a blunt stomach injury. In the further course of the process, bile escaping into the abdomen can lead to peritonitis, which is also associated with pronounced pain throughout the abdomen.
Liver and spleen tear
Both the liver and the spleen can be ruptured by sudden violent force on the body. This can happen, for example, in the event of a traffic accident or a severe sports injury. Martial artists who can tear their spleen or liver from a violent kick or blow to the upper abdomen are particularly at risk. Likewise, this type of injury occasionally occurs when riders fall from their horses. Only in very rare and particularly serious cases are the liver and spleen affected at the same time. The spleen tear is overall more common than the liver tear. Both organ injuries can lead to life-threatening internal bleeding within a short period of time, so that an operation usually has to be performed as quickly as possible.
Read more on this topic: Rupture of the spleen
Diagnosis of a ruptured liver
A ruptured liver is in most cases an emergency situation and therefore a very quick diagnosis is required.
A ruptured liver is not always easy to diagnose.
In most cases the diagnostic algorithm (sequence of examinations) is as follows:
- Ultrasonic
The ultrasound can quickly free liquid, e.g. Detect blood around the liver and abdomen
To do this, the surgeon procures a Abdominal incision Access to the injured organ. Often only then can the full extent of the injury be determined. The goal is then first of all the loss of blood through the Repairing large vessels, to stop and maintain as much functioning organ tissue as possible.
A frequently used one Primary method to stop the bleeding is what is called Packing the liver.
This is where the liver wrapped in belly towels and the bleeding so stopped by compression. The abdomen is then temporarily closed again and the patient is closely monitored, especially with regard to circulation and breathing. After about 48 hours will the Belly opened again and the sterile Cloths removedbleeding should be stopped.
Only in this second operation is the liver finally supplied with sutures. In other cases, destroyed liver tissue is removed during the first operation, destroyed blood vessels are sutured and the liver tissue that is still functioning is stitched together again.Since a tear in the liver is a serious illness acts, the person concerned usually has to in the intensive care unit for a long time will be closely monitored and will take several weeks to recover.
consequences
The most dangerous consequence of a ruptured liver is first of all severe blood loss. If larger vessels are injured, several liters of blood may bleed into the free abdominal cavity. Subsequently blood pressure falls of the person concerned and it can dizziness and Circulatory weakness up to Faint come.
The exit of Bile and blood in the abdominal cavity can also cause inflammation there, a so-called Peritonitis (Peritonitis), which is basically life-threatening.
A rupture of the liver is definitely one serious illness, the surgically supplied has to be and consequently leads to a longer hospital stay.
The Chance of recovery depends mainly on Age and the Pre-existing illness of the patient, as well as essentially from Blood loss of the patient. Depending on the extent of the injury and how severely the organ and large blood vessels are damaged, the Mortality up to 50% be.
If large parts of the damaged liver tissue have to be removed, the remaining tissue may not be able to fully perform the functions of the liver, resulting in liver failure. However, since the liver has the property of being itself regenerate, that is, "regrow", symptoms only appear after the removal of very large parts of the liver.
Liver rupture in children
In children, too, an external force of force on the upper abdomen can lead to a rupture of the liver. The capsule of the organ is not yet that strong and the bony chest also offers less protection than in adults, so that it is easier for the organ to tear in an accident. Possible causes are e.g. Falls on the handlebars while cycling, falls from climbing frames or from a horse while riding, as well as other play, sports or traffic accidents. Boys are much more likely to suffer from such injuries than girls. In children, symptoms of an internal injury, such as a ruptured liver, are often less evident. Therefore, early admission to hospital for monitoring after an accident should be considered. There is a big difference in the treatment of a ruptured liver in children. While an operation is usually performed in adults, it is often not necessary in children. Instead, close monitoring and control are carried out, as well as treatment with painkillers and infusions. An operation should only be performed if there is circulatory instability due to blood loss or if there is an additional injury to the intestine. However, this is only necessary in about five out of 100 cases. In general, such injuries in children are far less likely to be fatal or permanent than in adults. In most cases, recovery can be achieved without surgery.
