Is it possible to break off internal organs in a fall? Abdominal injuries and injuries: what to do? Basic methods of treating bruises of internal organs
4.3. Internal organ injuries
Strong blows to the abdomen, chest, lumbar region, perineum, especially if they are accompanied by fractures of the ribs, sternum, pelvic bones, can lead to damage to the heart, lungs, liver, spleen, intestines, kidneys, and bladder.
Heart damage. Several factors are involved in the mechanism of heart damage in blunt chest injuries:
1) direct physical impact on an organ with hemorrhage in its parts - myocardium, subendocardium or epicardium;
2) the influence of the central nervous system on the endocrine-vegetative regulation of heart activity (stress);
3) various metabolic disorders in the myocardium (redistribution of catecholamines, potassium, sodium, etc.), which lead to hypoxia and hypotension;
4) hyperfunction of the sympathoadrenal system, as a result of which the cardiotoxic effect of catecholamines increases.
There are four degrees (forms) of closed heart injury:
- shake;
Bruise (concussion);
Heart rupture;
Traumatic heart attack.
Shake - the mildest form of closed heart injury. It is characterized by the rapid development of short-term and mild clinical-cardiographic changes. Victims complain of aching, quickly passing pain in the heart area
The main symptom is arrhythmias (paroxysms of tachycardia, atrial fibrillation, atrial or ventricular extrasystoles), as well as conduction disturbances up to complete, albeit transient, transverse block of the heart or one of the legs of the atrioventricular bundle (bundle of His) Characteristic dizziness, fainting, short-term
hypotension.
At heart bruise subtle, non-penetrating myocardial ruptures are observed (the atria are affected more often than the ventricles), which can be accompanied by extensive hemorrhages involving subepicardial areas and the thickness of the myocardium. Sometimes they compress small branches of the coronary arteries, which leads to the formation of subsequent
common scar-altered areas. Often all the membranes of the heart become saturated with blood. In this case, the myocardium becomes flabby and unevenly saturated.
Characteristic constant or paroxysmal pain in the heart area, arrhythmias, expansion of the heart in diameter, shortness of breath, various changes on the ECG. In severe cases, heart failure develops.
Traumatic heart rupture - the most severe form of its closed injury. Traumatic myocardial ruptures are a common cause of death: they are observed in 10-15% of all those killed in car accidents
Ruptures of the right ventricle of the heart occur less frequently than the left; in 30% of the damage they are multi-chamber in nature; in UZ patients, pericardial ruptures simultaneously occur; in the rest, the pericardium remains unaffected, but there is a threat of cardiac tamponade with blood, and subsequently, with a favorable outcome, - development of pericarditis.
Cases of ruptures of traumatic aortic aneurysms, characterized by high mortality, have been described.
The consequence of a closed heart injury can also be pericarditis (inflammation of the pericardium) , coronary thrombosis and traumatic myocardial infarction, “dislocation of the heart” and its “compression”, traumatic heart hole, arrhythmias, myocardial dystrophy.
Damage to the pleura and lungs occur with bruises of the chest, its compression, fractures of the ribs and sternum, wounds from fencing weapons and athletics spears. In closed pleural injuries (without breaking the skin), the main role usually belongs to the end of the broken rib.
Lung contusion. In case of a lung contusion caused by a closed chest injury, characteristic clinical picture of hemorrhage in the lung, which is usually asymptomatic: hemoptysis, especially in the first 3-5 days, chest pain, apparently associated with damage to the pleura, shortness of breath and decreased breathing in the corresponding area of the lung, short-term fever, moderate increase in the number of leukocytes in blood and a slight acceleration of sedimentation
red blood cells
Due to the short duration of the changes (5-7 days), the most informative is an X-ray examination performed on the first day after the injury.
When pneumonia is added, there is an increase in symptoms, as well as a longer and higher increase in temperature, a pronounced increase in the number of leukocytes in the blood and the appearance of young forms.
When a lung is contused, hemothorax often develops - blood entering the pleural cavity, the clinical manifestations of which depend on the degree of blood loss, displacement of the mediastinum and compression of the lung by accumulated blood, the degree of destruction of the lung tissue and a decrease in pulmonary ventilation. The development of hemothorax may be accompanied by acute pulmonary heart failure.
At severe injury with multiple rib fractures There is a progressive development of respiratory failure caused by limited respiratory excursions and ineffective cough.
One of the most severe and early complications of thoracic injury is traumatic pleurisy. As a rule, it occurs within the first three days after injury. The effusion usually corresponds to the side of the injury, but may be bilateral or contralateral. Characteristic complaints of pain when breathing in the chest and shortness of breath.
Pneumothorax - the presence of air or gas in the pleural cavity. The entry of air into the pleural cavity inevitably leads to partial or complete collapse of the lung.
Depending on the cause of occurrence, traumatic, spontaneous (spontaneous) and artificial (therapeutic) pneumothorax are distinguished.
At open pneumothorax the pleural cavity communicates with the external environment through a gaping defect in the chest wall or bronchus.
The pressure in the pleural cavity is equal to atmospheric pressure (for small defects, it decreases slightly when inhaling and increases when exhaling). The lung completely collapses and is switched off from the act of breathing. The most severe phenomena arise due to the fact that the opposite lung, which in that case provides all gas exchange, begins to function under abnormal conditions. The negative pressure in the healthy pleural cavity cannot be balanced by the pliable and easily displaceable mediastinum, which is under
influenced by atmospheric pressure, it shifts towards the healthy lung, as a result of which the functional capacity of the latter is significantly reduced. Since the pressure in the intact pleural cavity fluctuates significantly during the respiratory phases, and on the side where the open pneumothorax occurred remains approximately constant, with each inspiration the displacement of the mediastinum increases, and with exhalation it decreases. As a result, the mediastinum
together with the vital organs contained in it, abundantly supplied with nerve receptors, undergoes more or less sharp fluctuations, “runs”. This leads to difficulty in blood flow through the vessels of the mediastinum and primarily through the vena cava, disruption of the heart and the occurrence of severe shockogenic reactions
At closed pneumothorax there is no communication between the air in the pleural cavity and the external environment.
In the pleural cavity, one or another level of negative pressure is usually maintained, at least at the moment of inspiration. In connection with this, the collapse of the lung on the damaged side is often incomplete. It partially takes part in gas exchange. The mediastinum shifts slightly and its fluctuations are expressed to a small extent. Respiratory and circulatory disorders with closed pneumothorax are much less pronounced than with open pneumothorax, and are quickly compensated after a short period of disturbances that are largely reflexive in nature (irritation of the pleura by infiltrated air)
Severe disturbances occur with valvular pneumothorax, usually observed with small defects chest wall, lung tissue or bronchus. With this type of pneumothorax, atmospheric air is sucked into the pleural cavity at the moment of inhalation, and during exhalation, when the pressure in the pleural cavity increases, the defect is covered and does not allow air to pass in the opposite direction. In some cases, air enters the pleural cavity during the exhalation phase.
The amount of air in the pleural cavity gradually increases, the lung collapses and is switched off from the act of breathing, and the mediastinum shifts to the healthy side, as a result of which severe respiratory and circulatory disorders can occur.
Urgent Care. At open pneumothorax(chest injury) first aid is to apply an airtight bandage, at least temporarily turning open pneumothorax into closed and reducing mediastinal fluctuations. Without such a bandage it is fatal the outcome may occur even before the ambulance arrives. The simplest airtight dressing consists of several layers gauze heavily soaked in Vaseline, on top of which compress paper or oilcloth is applied. After application an airtight bandage is urgently needed delivery of the victim to a special medical facility.
Closed pneumothorax, as a rule, does not require the use of urgent medical manipulations if there is no significant displacement of the mediastinum. However, even with a closed pneumothorax, the patient must be taken to the hospital.
At valvular pneumothorax it is necessary to deliver the patient as quickly as possible to a medical institution, where he will receive emergency care (unloading the pleural cavity from excess air using a puncture, i.e. inserting a special needle into the pleural cavity, in order to convert the valve pneumothorax into an open one).
Damage to abdominal organs may occur at the moment of impact in the hypochondrium area (with a football boot, a throwing projectile, when hitting surrounding objects, etc.), a fall from a great height (during diving) and through the mechanism of counter-impact against the spine and ribs (when ski jumping ). They are accompanied by symptoms of shock, expressed to varying degrees. Characteristic rapidly increasing internal bleeding (especially with ruptures of the parenchyma and capsule of the liver and spleen), pallor of the skin and mucous membranes, thread-like pulse, darkness or loss of consciousness, sudden tension in the muscles of the abdominal wall. When the intestines are damaged, inflammation of the peritoneum develops - peritonitis.
Urgent Care.
Traumatic injuries to the spleen account for 20 to 30% of all injuries to parenchymal organs.
There are one-stage and two-stage ruptures of the spleen.
With simultaneous ruptures, simultaneous damage to the parenchyma and capsule occurs. In these cases, bleeding into the free abdominal cavity from the ruptured spleen occurs immediately after the injury.
With a two-stage rupture, usually only one splenic parenchyma is injured at the first moment with the formation of a subcapsular hematoma. When repeated, often under the influence of a minor visible cause, the capsule ruptures and the hematoma breaks into the free abdominal cavity. Between the moment of injury and the breakthrough of blood into the free abdominal cavity, a certain period of time passes, calculated from several hours to several weeks and even months.
The clinical picture of splenic injury varies depending on the severity of the injury, the time elapsed since the injury, and the presence of concomitant injuries to other organs. The leading symptoms are acute blood loss and shock, which are accompanied by signs of peritoneal irritation.
Typically, victims complain of pain in the left hypochondrium, less often in the upper abdomen or throughout the entire abdominal cavity. The pain often radiates to the left shoulder and left shoulder blade.
Irritation of the peritoneum by engorged blood leads to tension in the abdominal wall and severe pain on palpation.
Massive bleeding, in addition to local symptoms characteristic of intra-abdominal bleeding, leads to the development of general manifestations of acute blood loss: rapidly progressing weakness of the victim, the appearance of tinnitus, dizziness, nausea, vomiting, cold sweat, pale skin, visible mucous membranes, etc. In severe cases, the patient may develop agitation, impaired consciousness, and a sharp drop in blood pressure.
With the formation of an extensive subcapsular hematoma, stretching of the capsule with gushing blood causes significant pain and a feeling of fullness in the left hypochondrium.
The prognosis depends on the severity of the spleen injury, the amount of blood loss and the nature of concomitant damage to other organs. The timeliness of surgical intervention is of decisive importance for the outcome of the disease.
Urgent Care. Apply cold to the affected areas, rest and urgent hospitalization (usually surgery is necessary).
Damage to the kidneys and bladder possible with a blow to the lumbar region, stomach (suprapubic region), or a fall from a height onto the buttocks. In the latter case, the kidneys suffer due to a blow to the spine and lower ribs.
Direct damage to the kidneys, which is accompanied by a bruise, is characterized by hemorrhages into the renal parenchyma, its edema and ischemia, vascular thrombosis and infarction, hematuria, and acute renal failure.
Kidney damage is accompanied by a state of shock, the appearance of blood in the urine or the formation of a perinephric hematoma. In this case, acute renal failure may develop.
Bladder rupture is accompanied by urinary retention, which quickly flows into the peri-vesical tissue. The state of shock is deepened by the phenomenon of intoxication.
Urgent Care. Apply cold to the affected areas, rest and urgent hospitalization (usually surgery is necessary).
Injuries associated with mechanical impact on the human body are the most common in medical practice. The main reasons for their appearance:
Impact with a blunt object.
- Collision with an object that is very hard (usually found in road accidents).
- Fall from a great height.
Symptoms of bruises of internal organs
The nature of the damage resulting from bruises depends primarily on the degree of mechanical load and on the area of the body to which this load was directed. For example, if we are talking about a chest bruise, pathological changes in the lungs, heart, trachea, etc. are possible. If the main mechanical load falls on the abdominal area, the stomach, spleen, liver, kidneys, etc. may be significantly damaged. A head injury is often accompanied by a brain contusion, the consequences of which can be extremely serious. However, signs of a concussion are a topic for another discussion. How to recognize bruises of internal organs in other cases?The main symptoms that allow us to draw conclusions about a bruise of internal organs:
Severe pain in the damaged area.
- Presence of a hematoma in this area.
- Swelling of soft tissues in the damaged area. This condition is usually caused by internal hemorrhage.
- Impaired functionality of the organ that was affected.
Manifestations may vary depending on which organ was affected. In general, external signs of bruises to internal organs can be described as follows:
Growing subcutaneous emphysema (excessive accumulation of air in the tissues, accompanied by severe pain).
- If the lungs are damaged, cyanosis (bluish coloration of the skin) and respiratory distress are observed.
- Decreased blood pressure, decreased heart rate.
- Injuries to organs located in the abdominal cavity are often manifested by a feeling of fullness in the stomach and nausea.
- Hemoptysis.
If the kidneys, liver, or spleen are damaged, internal bleeding can be very severe. Any injury that causes injury to internal organs requires professional medical attention.
Basic methods of treating bruises of internal organs
First aid for suspected bruises of internal organs due to a fall is to ensure the victim’s rest. It is also necessary to take emergency measures:Apply ice or a cold compress to the injured area.
- To avoid anaphylactic shock, the patient must take a pain reliever.
- In some cases, a tight bandage is indicated (for example, with a closed chest injury).
Severe bruise of internal organs following an accident requires immediate hospitalization. In a hospital setting, a thorough diagnosis is carried out, which helps to identify the size and area of distribution of damage to internal organs. The main diagnostic method is x-ray, and in case of a brain injury, computed tomography or magnetic resonance imaging (MRI) may be required. In case of a chest bruise, the doctor will prescribe an ECG - an electrocardiogram, the interpretation of which will help to obtain a more objective picture of the disease.
Treatment usually comes down to surgery, which is carried out to stop internal bleeding and restore the integrity of the damaged organ. If the injury was not severe, to eliminate the hematoma 3-4 days after the injury, you can rub the damaged area with ointments that have an anti-inflammatory effect (without the warming effect). Source -
Abdominal bruise is a serious injury that occurs very often. On average, it accounts for up to 4% of the total number of bruises. At the same time, they are classified as one of the most severe, since the likelihood of death is high. Statistics of deaths from injury say that abdominal injuries occupy third position, second only to craniocerebral injuries and in terms of the number of deaths. A bruise can be caused by a fall, an accident, natural disasters, or a fight.
Contusion of the anterior abdominal wall in accordance with the international classification of diseases ICD 10 suggests that the classifier code is S30.1. This is an injury to the abdominal wall. Section S30 includes the lumbar, pelvic, and lower back areas.
Reasons
Bruises of the anterior abdominal wall in both children and adults are called abdominal by medical staff. They are distinguished by a large number of possible functional disorders and loss of anatomical integrity.
Most often, abdominal injuries in children and adults are closed-type injuries, accounting for about 85% of the total number. Open damage is only 15%, and their main causes include the following:
- Falling from a height, including landing with the abdominal wall on sharp surfaces or elements.
- Various wounds from firearms or cold steel (knife).
The consequences of such wounds can be different - bleeding, organ prolapse. If the latter is present, it is not allowed to reset the organs yourself, so as not to harm the victim.
There are many more causes of closed blunt abdominal injuries, the main ones include:
- Exposure to iatrogenic factors, including therapeutic effects and risks.
- Accidents that may occur in the workplace.
- Falling on various objects - hard and blunt.
- Strikes.
- Ingestion of aggressive chemicals, which include acids and alkalis, and objects with sharp corners.
Symptoms
The main characteristics of abdominal contusion include a large number of severe injuries, the need for postoperative intervention and the presence of subsequent complications, and a high mortality rate.
Signs of open and closed injuries are fundamentally different. These differences include:
- Receipt mechanism.
- The severity of the condition.
- Methods for diagnosing damage and subsequent treatment.
- The final outcome.
All this leads to the fact that symptoms of damage of different types are considered separately. Symptoms may be as follows:
- Injury to the abdominal wall. They are characterized by swelling and pain. The pain intensifies during sneezing and coughing, with a sudden change in body position and during bowel movements.
- Ruptures of fascia and muscles. The symptoms are basically the same, but the abdominal pain is more pronounced.
- Rupture of the small intestine. The main manifestations are vomiting, rapid pulse, and a feeling of muscle tension.
- Colon rupture. The signs are similar to the injury described above, but the appearance of shock from pain is more common, and there may also be internal bleeding.
- Closed abdominal injuries. A common consequence is internal bleeding, fainting, low blood pressure, pale skin, bladder rupture.
- . These are primary and secondary injuries, the latter usually observed in children. There is severe pain and spontaneous bleeding. There are also symptoms of painful shock.
- Pancreatic injuries. This could be a bruise, a concussion or a rupture.
- . Pain in the lumbar region, blood in the urine, and increased body temperature are observed.
With any type of injury there are soft tissue bruises and bruises.
First aid
A bruise of the abdominal wall necessarily requires primary care. When providing first aid for abdominal bruises, do the following:
- The patient should lie in a comfortable position.
- You need to put something light and cold on your stomach.
- If there are no visible signs of injury, the symptoms are clarified in order to give the person a painkiller. Injection of ketorolac or 50% metamizole solution is allowed. For open injuries, you can use narcotic painkillers, for example, trimeperidine.
- After providing primary care, the patient is quickly taken to the nearest medical facility or an ambulance is called.
The specifics of first aid do not differ depending on how the injury was received, for example, in an accident or a fall from a height.
Diagnosis and treatment
A contusion of the anterior abdominal wall can have varying severity. The main difficulty is the absence of external wounds and bleeding. Internal blood loss is observed, which worsens the patient’s condition and complicates the initial diagnosis. In any case, in the presence of closed and open abdominal injuries, immediate surgical intervention is required.
Therapeutic methods of diagnosis and treatment are selected immediately after the initial diagnosis. They allow you to stop or prevent bleeding of internal organs and the possibility of peritonitis. Further treatment is often surgical.
Diagnostics assumes the following:
- Blood and urine tests.
- Electrocardiogram.
- X-ray to determine the extent of damage.
- Ultrasound examination to determine the presence of bleeding.
- Computed tomography.
- Catheterization technique if there is suspicion of bladder rupture.
- Laparoscopy.
Treatment of open and closed abdominal trauma differs. Any open wounds necessarily require prompt surgical intervention. Penetrating wounds are treated depending on the organ injury. Non-penetrating injuries require surgery and irrigation of the area. After the operation, structures that are not viable are excised and sutures are applied.
Clinical surgery of other injuries involves the following:
- Surgical treatment methods are in demand for fascia and muscle ruptures, bruises
- Large hematomas are opened under local anesthesia. Finally, apply a sterile pressure bandage.
- Organ injuries require rapid surgery and blood transfusions.
- Patients are prescribed bed rest, physical therapy, and infusion therapy.
- During the postoperative period, antibiotics and analgesics are prescribed.
Complications and consequences
Contusion of the anterior wall and stomach can have a number of complications:
- Development of peritonitis.
- Internal bleeding, which leads to a sharp deterioration of the condition. Possible death from massive blood loss.
- Abdominal sepsis.
- Septic shock.
- Enteral failure.
Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.
A bruise is a closed injury to soft tissue. There is probably not a single person who has not experienced this type of injury. In most cases, bruises do not require treatment and heal on their own. As a rule, with a bruise, there is no violation of the integrity of the tissue, except for the rupture of small vessels (capillaries). But sometimes a bruise can cause significant damage, such as a head injury. In addition, the bruise may accompany other wounds, such as a fracture. In this case they talk about bruised wounds.
Symptoms of bruise
The symptoms of a bruise are known to everyone - sharp pain in the immediate area of injury, swelling and redness. In the case of a minor bruise, the pain subsides after a few minutes, and a hematoma appears at the site of redness, which is popularly called a bruise. A hematoma occurs due to hemorrhage resulting from the rupture of small capillaries. The size of the hematoma does not always depend on the severity of the bruise. The permeability of the capillaries is important, as well as the location where the bruise occurred. In people with increased capillary permeability, a minor bruise or even a careless touch can cause a significant hematoma, while a severe bruise may not manifest itself as an external hematoma, while internal bleeding will be quite significant.
Pain after a severe injury is a more persistent symptom. The nature of the pain changes over time, from sharp at first, when exposed to a traumatic factor, to aching later. Pain that persists for a long time after a bruise is an unfavorable symptom and a reason to seek medical help, as it may indicate damage to internal structures (fracture, bruise with hemorrhage of an internal organ, ligament rupture, concussion, etc.). Most often, distant pain after a bruise is associated with the formation of a hematoma, which compresses the nerve endings, especially when touching or moving the injured part of the body.
A symptom of a joint bruise is significant swelling. A symptom of a head injury is a severe headache. You need to know that if a head injury causes a loss of consciousness, even a short-term one, or the victim cannot remember the moment of injury, this is a sign of a concussion. In this case, medical intervention is necessary, at least diagnostics for the presence of an intracranial hematoma.
If there is a bruise to the chest, abdomen or abdomen, the symptoms of the bruise can be quite serious. Signs of damage to internal organs, such as the appearance of blood in the urine, weakening of breathing, increasing pain, clouding of consciousness, in a word, increasingly increasing rather than decreasing symptoms of a bruise, should be a reason to immediately seek medical help.
Consequences of a bruise
In the vast majority of cases, mild and even severe bruises pass without consequences, or the consequences of the bruise disappear without a trace within two to three weeks. However, there are situations when the consequences of a bruise can be quite serious. First of all, this applies to the already mentioned head contusions. The fact is that the skull is a closed space, and the hematoma, which in any other place of the body would resolve over time without causing significant concern, in the skull leads to compression of vital brain structures. In this case, the consequence of a bruise can be neurological disorders of varying severity and localization, severe headache accompanied by nausea and vomiting, and even death.
One of the consequences of a bruise, although quite rare, can be the calcification of a hematoma. In this case, a compaction remains in the soft tissues, which can cause quite significant pain when moving. In some cases, a long-term consequence of bruising the soft tissue of the mammary gland in women or the testicle in men can be the development of a malignant tumor of these organs.
A serious consequence of a bruise is a violation of the integrity of a large vessel. In this case, significant hemorrhage and even internal bleeding is possible, the formation of a blood clot is possible, followed by a serious complication - thromboembolism, when a blood clot with the movement of blood enters a vessel of a smaller diameter and blocks it. Thromboembolism can lead to heart attack, stroke, necrosis of an internal organ, and death.
Also of significant danger are the consequences of bruises of internal organs, for example, bruise of the heart, bruise of the kidneys, liver, spleen. In this case, various damages and disruptions of their functions are possible, which pose a danger to life.
Considering all of the above, do not underestimate bruises, especially serious ones.
Help for bruises
Everyone knows how to provide assistance for bruises, but not everyone knows how to provide assistance for bruises correctly. First aid for a bruise is to examine the damaged area, if it is a limb, then check its functions (flexion-extension, other movements). If there are only symptoms of a bruise, and not a more serious injury, it is necessary to apply cold to the injured area. This causes spasm of the microvasculature and helps stop internal hemorrhage.
It is better not to use painkillers so as not to miss the deterioration of the condition in case of additional complications. However, if you are sure that the bruise has not damaged the internal organs, you can give an anesthetic drug, with the exception of aspirin (acetylsalicylic acid). Aspirin should not be used to treat bruises, as it increases bleeding.
If there is a severe bruise of the head with loss of consciousness, a severe bruise of the lower back, abdomen or chest, in addition to applying a cold compress, the victim must be laid down and called an ambulance, or taken to the emergency room on your own, trying, if possible, to immobilize the bruised area and maintain peace.
It must be remembered that cold is effective only during the first thirty minutes. Then the necessary help for a bruise consists of giving rest to the bruised area. Two days after the injury, gentle heat is required on the damaged area. Applying a warm compress during this period ensures blood flow to the site of the bruise, which accelerates the resorption of the hematoma without the risk of resumption of bleeding.
Treatment of bruises
Treatment of bruises is required when a significant injury occurs. Bruises of the head, abdomen, lower back and chest require hospitalization in the surgical department, where, after appropriate diagnostics, a decision is made on further treatment of the bruise. In severe cases, surgical treatment of the bruise is performed. Access to the damaged area is carried out either endoscopically or openly, ruptures of large vessels, ruptures of parenchymal organs are sutured, and spilled blood is removed. Then the wound is drained. In parallel, anti-inflammatory and painkillers are prescribed.
Treatment of a bruise in the regeneration stage consists of the use of physiotherapy in order to accelerate the resorption of the hematoma and the speedy restoration of damaged tissues.
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The liver is an internal human organ responsible for important body functions. For the normal functioning of internal systems, a healthy state of the organ is necessary. However, it is not only the toxic effects of toxic substances that can damage the liver. A liver bruise received during a blow or fall can damage the integrity of the blood vessels and structures of an important organ, and if pre-medical and medical care is delayed, the injury can lead to death.
Depending on the external manifestations and the formation of other symptoms associated with the well-being and general condition of the patient, narrower criteria are identified that conditionally divide liver injuries into several categories.
Depending on the cause of blood in the abdominal cavity:
- Bile duct injuries.
- Vessels passing inside the liver.
- Vessels located outside the liver.
Depending on whether injuries occurred in the internal area or with violations of the integrity of the fibrous membrane, injuries are divided into two groups.
If the fibrous membrane of the abdominal organ has not been damaged, injuries are divided into categories:
- bleeding is located under the liver capsule;
- hematomas and bleeding form in the central region of the organ.
If the fibrous membrane of the abdominal organ is damaged, injuries are divided into categories:
- formation of one or more cracks;
- crushed liver;
- division of the organ into functionally inferior segments;
- formation of large damage to the bile ducts;
- gallbladder damage;
- damage to the gallbladder and biliary system of an individual nature (without injuries to the liver segment).
Signs that appear in the first hours after injury indicate the degree and severity of the injury, since, in addition to classification by location, injuries are divided according to the strength of the injury:
- closed injuries of an internal organ, the depth of which does not exceed 2 cm;
- the depth of damage reaches half of the entire thickness of the organ;
- the depth of damage exceeds half the thickness of the organ;
- there is a division of the liver into fragments due to multiple ruptures in a person.
A timely visit by an injured patient to a medical facility for examination or calling an ambulance is the most important stage in recovery and even saving a person’s life. are especially dangerous due to the lack of protective skeletal structures and the presence of large blood vessels.
Trauma code according to ICD 10
ICD 10 is an international classification of infectious diseases, injuries and congenital pathologies of the human body. The latest changes to the classification characteristics were made in 2016.
According to ICD 10, liver injuries belong to the block “Injury of the abdominal organs (S36)”, and has its own section “S36.1 - Injury to the liver or gallbladder”.
Reasons
The human body is a very delicate and fragile mechanism, which makes many factors acting from the outside world detrimental to the health and general condition of people. Thus, liver contusion is possible as an independent phenomenon, and as an accompanying injury.
Causes of liver contusion:
- traffic accident;
- impact when falling;
- blow from a blunt object to the abdomen (blow to the abdomen without external damage to the skin);
- squeezing a person's body between two objects;
- excessive tension in the abdominal muscles in infants;
- lifting heavy weights;
- internal disorders of the organ structure and liver diseases.
When, due to damage, hematomas (bruises) of various sizes form on the liver and neighboring tissues, such manifestations are associated with injury to the blood vessels and functional parts of the internal organ.
Diseases of the musculoskeletal system (musculoskeletal system) provoke the development of bone fragility; skeletal diseases are a common cause of disruption of the integrity of internal organs during fractures.
Symptoms
Liver bruise is characterized by noticeable symptoms, the identification of which allows you to save a person’s life.
Symptoms of liver contusion:
- Painful symptoms from such an injury are distinguished by a stabbing nature and varying degrees of manifestation (from severe to mild pain). Pain sensations are concentrated in the area of the injury (on the right side) and intensify during movements and changes in body position.
- If a person has received multiple injuries, the pain spreads to the entire abdominal area, lower back and groin area (diagnosis depends on the cause that led to the appearance of the disorders and the primary area of injury).
- The injury is accompanied by massive internal bleeding. Accumulation of blood in the abdominal cavity - this symptom can be isolated (without painful manifestation) due to the occurrence of traumatic shock of 2 or 3 degrees.
- After liver damage, blood pressure increases significantly, but after blood begins to accumulate in the abdominal cavity and blood loss reaches 800 ml, blood pressure decreases markedly.
- Changes and disturbances in heartbeat, pulse fluctuations.
- If intestinal damage occurs during an injury, bloating may occur.
- Tension of the abdominal muscles and lack of mobility when breathing.
- The Shchetkin-Blumberg symptom is a cutting pain that occurs after a certain period of time after injury; pain appears when the hand pressure is reduced during diagnostic palpation.
- Kulenkampf's sign is general softness of the abdominal wall or slight tension.
- After several days have passed after the injury, signs of jaundice appear (changes in the color of the skin and mucous membranes, a yellow tint to stool and urine, itchy sensations on the skin), leukocytosis, an increase in temperature to 37-38 degrees, and an increase in the size of the internal organ. Symptoms appear in the absence of diagnosis and treatment within a period of 2-3 days.
It is worth noting that the appearance of clinical symptoms of damage in children may appear much later than in adults.
First aid
First medical aid after injury is an important step in preserving the life and health of the victim.
It often happens that after receiving a liver injury, the patient is in a state of severe painful shock, or unconscious - in this case, the first step is to return the patient to consciousness.
What to do if you have a liver injury:
- Lay the victim down so that it is comfortable, but without putting pressure on the abdomen.
- Apply cold to the bruised area.
- Use anesthetic injections (you cannot take medications or liquids orally, as they can increase the load in the abdominal area).
- After receiving an injury, blood begins to accumulate in the victim’s abdominal cavity, so to provide assistance and diagnose possible ruptures, it is necessary to call an ambulance or take the patient to a medical facility.
Hospitalization is necessary due to the use of an oxygen mask and other means of resuscitation. In case of a delay that lasts several days (depending on the severity of the injury received, the time is reduced), the victim may die.
Diagnostics
Liver contusion and gallbladder damage are diagnosed in a medical facility using:
- ultrasound examination (ultrasound);
- computed tomography;
- laparoscopy.
Treatment for liver contusion is determined after identifying the extent of damage.
Treatment
After diagnosis, the doctor prescribes a treatment method:
- Intravenous injection of fluid into the body.
- Surgery is being performed. During severe closed liver injuries, bleeding into the abdominal cavity is likely; in this case, surgical bleeding is stopped and, in some cases, even a section of the organ is removed. Reinfusion is performed (transfusion of the patient's own purified blood).
- Therapy with medications (including taking antibiotics).
- Rehabilitation course (observation at a dispensary for a month).
Pay attention!
Self-medication and the use of traditional methods for liver damage are strictly prohibited. Even taking into account the high level of organ tissue regeneration, diagnosis and elimination of internal damage is vital.
Indications for surgical intervention include:
- formation of a closed injury with severe bleeding;
- development of anemia within 3 days after injury;
- hemobolia;
- biligemia;
- liver abscess;
- separation of a segment of an internal organ.
Monitoring the patient’s condition in a hospital setting allows for quick assistance in the event of complications developing in the later stages of rehabilitation.
Complications and consequences
Liver contusion has serious consequences if treatment rules are not followed or assistance is not provided in a timely manner.
Possible complications:
- Tissue necrosis, sepsis.
- Hemobilia, biligemia.
- Development of an abscess (suppuration in the area of the hematoma).
- Cyst formation in liver tissue.
- Subphrenic abscess.
- Liver failure, intrahepatic abscess, bleeding of liver vessels.
- Bleeding in the first 3 days after surgery or diagnosis.
- Fibrinolysis.
- Peritonitis.
- Decreased mobility of the diaphragm dome in the right area.
- Changes in the position of the colon and stomach.
Serious consequences can also be caused by home treatment and reluctance to see a specialist. It is important to remember that complications from a liver contusion must be treated immediately after the first signs appear, otherwise death is possible.
A liver injury does not provoke the development of cancer.
Conclusion
Liver bruise is a serious injury that can be accompanied by severe hemorrhage in the abdominal cavity and disruption of the gallbladder. Treatment takes a long time and requires complex surgical operations. Timely provision of pre-medical and medical care can improve a person’s general condition and save his life.
Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.
