INTRODUCTION• The liver is the largest solid abdominal organ with a relatively fixed position, which makes it prone to injury. The liver is the second most commonly injured organ in abdominal trauma, but damage to the liver is the most common cause of death after abdominal injury.
DEFINITION• Liver trauma is caused by landing, or being hit, on the right chest or upper abdomen.
CAUSES• Blunt (nonpenetrating) abdominal injuries usually result from motor vehicle accidents, fights, falls from heights, and sports accidents.• Penetrating abdominal injuries usually result from stabbings and gunshots.
PATHOPYSIOLOGY The liver is also vulnerable to penetrating trauma. Liver injuries present a serious risk for shock because the liver tissue is delicate and has a large blood supply and capacity. Liver may be lacerated or contused, and a hematoma may develop. It may leak bile, usually without serious consequences.If severely injured, the liver may cause exsanguination(bleeding to death).
SIGN AND SYMPTOM• In blunt trauma, there will often be fractures of the 7-9th ribs overlying the liver make it feel pain.• Right upper quadrant tenderness will be present.
DIAGNOSTIC TEST1. If the patient is stable,CT scan of the abdomen may demonstrate a laceration that can be managed non- operatively. 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 confirm intraperitoneal hemorrhage. Finding bile on peritoneal lavage means biliary tract injury.
TREATMENT• Large lacerations and gunshot injuries require laparotomy and repair. Many small lacerations can be followed conservatively.
COMPLICATION• Severe liver injuries often lead to exsanguination, which is the most common cause of death.• Hemorrhage and hypovolemic shock. Later complications include infection and dysfunction of organs.
NURSING CARE PLAN 1 Nursing diagnosis:• Acute or chronic pain related to injuring organ. Goal:• The client level of pain will controlled.
CON’T…NURSING INTERVENTION 1. Investigate changes in frequency or description of pain. Rationale: May signal worsening of condition or development of complications. 2. Monitor heart rate, BP using correctly sized cuff, and respiratory rate, noting age appropriate normals and variations. Rationale: Changes in autonomic responses may indicate increased pain. 3. Administer medications, such as opioid and nonsteroidal analgesics, as indicated. Rationale: pain management may be needed to overcome or control pain.
NURSING CARE PLAN 2 Nursing diagnosis:• Anxiety related to anticipated loss of physiological well-being, change in body function perceived death of client . Goal:• Client will more understanding to the situation.
CON’T…NURSING INTERVENTION 1.Inform client about planning to do and why. Include client in planning process and provide choices when possible. Rationale: Enhances sense of trust, and explanation may increase cooperation and reduce anxiety. Provides sense of control over self in circumstance where loss of control is a significant factor. Note: Feelings of self-worth are intensified when one is treated as a worthwhile person. 2. Reorient frequently. Rationale: Client may experience periods of confusion, resulting in increased anxiety. 3. Administer medications, as indicated, for example: Benzodiazepines, such as chlordiazepoxide (Librium), and diazepam (Valium) Rationale: Anti-anxiety agents are given during acute withdrawal to help client relax, be less hyperactive, and feel more in control.