The liver is a vital organ of the body responsible for blood volume regulation, immune system support, macronutrient metabolism, and lipid and cholesterol homeostasis. It also helps to filter toxic substances out of your system. It is located in the upper right-hand side of your abdomen, beneath your diaphragm.
The liver is also responsible for producing an important substance called bile. Bile excretes red blood cell remnants and breaks down fats into fatty acids, which can be taken by the body via the digestive tract.
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A bruised liver occurs when small blood vessels open and leak blood into neighboring tissues. The liver is the most commonly injured organ by blunt abdominal trauma and second most commonly injured in penetrating trauma — making up 5% of all trauma admissions. It is prone to being affected due to its fragile tissue and location in the body.¹
The capsule of the liver is thin but has high blood flow (is highly vascular), so injury is generally associated with high blood loss. A liver injury may be caused by direct or indirect contact — for example, a fractured rib can result in liver damage.
Other causes of a bruised liver can include falls, motor vehicle accidents, and pedestrian accidents. Hits to the liver can also occur in sports, including ball sports, or from a direct punch or kick to the liver.
Injury types to the liver vary, including:²
Hematomas: a collection of blood outside of blood vessels, generally caused by an injury to a blood vessel
Lacerations: a cut (laceration) in the liver
Vascular: any injuries damaging vessels
And these injuries are commonly graded into five grades, according to the American Association of Surgery for Trauma (AAST). Severity is then quantified based on the presence and location of a hematoma or laceration and the volume of the liver tissue that has been affected.
If you have been in an accident or experienced some form of trauma, then it’s vital you seek medical attention. The faster you do this, the better you’ll reduce the potential of any unwanted complications.
Although you may not have any symptoms or outward bruising, it’s still possible that your internal organs have suffered some damage — highlighting the importance of seeking medical attention.
If your injury is severe and you’ve arrived at the hospital via emergency services, then your initial assessment will involve ABCDE for immediate treatment:
Airway: Ensuring the airway is not obstructed
Breathing: Checking that breathing is sufficient
Circulation: Is circulation sufficient?
Disability: What is the level of consciousness — is the patient responding?
Exposure: Are there clues to the cause of the patient's condition?
This ABCDE procedure is carried out to assess if there are any life-threatening problems present. Intervention should continue until you become stable.
If you are able to respond, your doctor will then ask you questions about the mechanism of your injury to determine if a liver injury has occurred. This may be followed by a physical examination; for example, to determine if there is tenderness in the upper right quadrant of the stomach, where the liver is located.
Imaging techniques will be used to determine the presence of liver damage. A spiral computerized tomographic (CT) scan is part of the standard protocol for patients with an abdominal injuries. A CT scan is a technology that uses X-rays and a computer to produce a detailed image of structures within your body — it is highly sensitive to injuries in the liver.
Angiography may be carried out to diagnose vascular damage to your liver. In an angiogram, images are produced of your blood vessels. Ultrasound is also used, which is a technique that uses sound waves to produce images from your body.
This technique enables doctors to create an image of your liver and assess whether any potential damage is present — they can do this rapidly and usually directly in the ER.
Once your liver damage has been assessed, doctors will be able to determine an appropriate treatment protocol.
Pain that worsens when you breathe deeply
Low blood pressure due to blood loss (lightheadedness, dizziness, blurred vision, feeling weak)
Swelling of the belly
Bruised skin over the injured area
Generally, liver damage can be managed non-operatively if the patient is hemodynamically stable.
An operation may be necessary in more severe cases — for example, to ligate (tie off) bleeding vessels and repair injury to the veins. IV fluids will likely be administered to restore blood pressure to normal levels.
Other ways you can help your recovery are by resting and avoiding alcohol to boost your recuperation and minimize complications.
Treatment also depends on the severity of the damage.
In the case of minor bruising, you may be discharged from the hospital fairly quickly. It is likely that you will be advised to rest and avoid any high-intensity activities.
In the case of major damage, surgical intervention may be required — this is necessary for patients who are hemodynamically unstable, to control the bleeding. It may also be required to control bile leakage from the liver. You may be admitted into the intensive care unit (ICU) to reduce the risk of complications or mortality.
Mortality from liver injury depends on the severity of the injury. The good news is that 80–90% of liver injuries are low-grade (Grade I-II). Most liver injuries can be managed without the need for surgical intervention. Improvements in imaging technology mean that quick diagnosis and response are also possible.
However, more severe cases of liver injury can result in death — severe abdominal trauma has around a 10–15% mortality rate due to liver injury.
Typically, in blunt trauma to the liver, complications occur in around 12–14% of patients. Symptoms suggesting complications include jaundice, elevated inflammatory response, or fever.³
Bleeding/hemodynamic instability: Hemodynamics refers to the blood flow in your blood vessels. Hemodynamic instability can occur following a liver injury when there is bleeding within the abdomen. It is important that this is responded to promptly — as delaying the control of bleeding and the potential need for surgery is associated with higher mortality.
Abdominal compartment syndrome (ACS): ACS occurs when the pressure in the abdominal cavity increases significantly, causing associated organ dysfunction.
Infection: Infection can result from collections of blood or bile following injury to the liver.
Bilomas: A biloma is a collection of bile within the abdominal cavity. Hemobilia and biliary fistula are other bile-related complications. A biloma is a rare complication and can either be a direct consequence of liver trauma or surgical intervention.
If you’ve suffered any trauma to your abdomen or you are experiencing any of the symptoms outlined above, then it’s important to speak to your doctor to rule out liver damage or obtain appropriate treatment.
The liver is a vital organ in the body that carries out many important roles. Liver bruising can result from sports, falls, and traffic incidents and can be mild in severity, though, in some cases, liver injury can be life-threatening. Treatment is available, and, generally, surgery can be avoided, depending on the severity of the injury.
As with any injury, the recovery time will depend on how severe the injury was. For something minor, you may only experience pain for a few days. In the case of severe liver injuries, you may find that you need to cut back on activities for a few months to achieve a full recovery and pain-free activity.
A bruised liver may feel sore or tender in the upper right side of your abdomen and under your right ribs. The severity of the pain will vary depending on how your liver was injured.
If physical examinations show that the injury is just bruising, then it is possible that your liver will heal on its own, and you will just be required to rest and have a follow-up appointment with your doctor to assess recovery.
The liver (2017)
Injury scoring scale | The American Association for the Surgery of Trauma
Management of liver trauma (2009)