injuries poisoning
Hepatic Injury
Etiology of Hepatic Injury
Significant impact (eg, motor vehicle crash) can damage the liver, as can penetrating trauma (eg, knife wound, gunshot wound). Hepatic injuries range from subcapsular hematomas and small capsular lacerations to deep parenchymal lacerations, major crush injury, and vascular avulsion. Hepatic injuries are classified according to severity into 6 grades. Grade Grade Injury Injury 1 Subcapsular hematoma < 10% of surface area Laceration < 1 cm deep 2 Subcapsular hematoma 10‒50% of surface area, intraparenchymal hematoma < 10 cm Laceration 1‒3 cm deep and < 10 cm long 3 Subcapsular hematoma > 50% of surface area, intraparenchymal hematoma > 10 cm or any expanding or ruptured hematoma Laceration > 3 cm deep 4 Parenchymal disruption involving 25‒75% of a hepatic lobe or 1‒3 Couinaud segments within a single lobe 5 Parenchymal disruption involving > 75% of a hepatic lobe or > 3 Couinaud segments Juxtahepatic venous injuries (ie, retrohepatic vena cava or central major hepatic veins) 6 Hepatic avulsion 