Non-penetrating Injuries To The Liver Or Spleen

WHAT YOU SHOULD KNOW:

  • Non-penetrating injuries are also called blunt injuries. These are injuries resulting from a direct force on the abdomen without an open wound. Blunt injuries to the liver or spleen may include tears, cuts, or bruises to the organ. These injuries may lead to internal bleeding due to organ rupture (burst) or blood vessel problems. The liver and spleen are large organs located at the upper area of the abdomen (stomach). Car accidents, falls, or blows to the abdomen may injure these organs. Broken ribs may pierce the liver or spleen inside your body.

  • You may have abdominal pain, especially when moving, and your abdomen may be hard and tender. There may be bruising, swelling, or scratches on the abdomen over the injured area. A complete check-up of your body, including your skin, chest, back, and abdomen, may help diagnose blunt injuries. Imaging tests that take pictures of your abdomen, such as x-rays, ultrasound, and computerized tomography (CT) scan, may be done. Treatment will depend on your symptoms, condition, and how severe your injuries are. Sometimes, watchful waiting may be all that is needed for mild injuries. You may have surgery or other procedures to treat bleeding or more severe organ injuries. With proper care and treatment, your liver or spleen may heal over time, and serious problems may be prevented.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Treatment for blunt injuries of the liver or spleen carries certain risks. Surgery may cause you to bleed too much or other parts of your abdomen to be damaged. Draining the abdomen of blood or bile (brownish fluid) may cause an infection. After surgery, you may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.

  • If an injury to the liver or spleen is left untreated, medical problems could develop or worsen. Blunt injuries may cause internal bleeding and be life-threatening. Ask your caregiver if you are worried or have questions about your condition, care, or treatment.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

An IV

is a small tube placed in your vein that is used to give you medicine or liquids.

Jejunostomy tube (J-Tube):

A jejunostomy tube is a small, flexible tube that is put into a small cut in your abdomen. The end of the tube goes into your small intestine (bowel). The tube is used to give you liquids, food, and medicine. You may have a J-tube for a short time, or long-term. If you need it long-term, your tube may need to be replaced with a new one at certain times.

Medicines:

You may be given the following medicines:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

Special lines:

Special tubes may be put into your blood vessel (artery or vein). These tubes help caregivers watch how you are doing. You may need the following lines:

  • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

  • Central line: This is a special IV catheter or tube. It is put into a large vein (blood vessel) near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. Other central lines, such as a PICC, may be put into your arm. You may need a central line to receive medicines or IV fluids that need to be given through a big vein. You may need a central line if it is hard for caregivers to insert a regular IV. Also, a central line may stay in longer than a regular IV can. Some central lines may also be used to take blood samples.

Tests:

One or more of the following tests may be done. Certain tests use a special dye to help organs and structures show up better. Tell caregivers if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye.

  • Angiography: This test looks for problems with blood flow in your abdomen. A catheter (long, thin, bendable tube) is placed in a blood vessel in your groin. The groin is the area where your abdomen meets your upper leg. A dye is put into the catheter. Pictures are taken using an x-ray or a CT scan after the dye goes to your abdominal organs.

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • Computerized tomography scan: This is also called CT scan. A special X-ray machine uses a computer to take pictures of different areas of your abdomen and pelvis. It may be used to look at your bones, organs, and blood vessels. Before taking the pictures, you may be given dye through an IV in your vein.

  • ERCP: ERCP is also called endoscopic retrograde cholangiopancreatography. This test is done during an endoscopy to find injuries, stones, tumors, or other problems. Dye is put into the endoscopy tube.

  • Peritoneal lavage: A peritoneal (per-i-toh-NEE-al) lavage (lah-VAHZH) checks the fluid in your abdomen for signs of blood, bile (fluid from your gallbladder), or stool. Caregivers put a needle or plastic tube into a small incision (cut) in your abdomen. Liquid is given through the tube into your abdomen. The fluid is removed and may be sent to a lab. This test will help caregivers know if there is a problem with one or more organs in your abdomen.

  • Abdominal ultrasound: This test is done so caregivers can see the tissues and organs of your abdomen. Gel will be put on your abdomen and a small sensor will be moved across your abdomen. The sensor uses sound waves to send pictures of your abdomen to a TV-like screen.

  • X-rays: X-rays of different parts of your body may be taken. These may include your chest, abdomen, and pelvis. X-rays may help caregivers look for broken bones or other injuries.

Treatment options:

  • Blood transfusion: You will get whole or parts of blood through an IV during a transfusion. Blood is tested for diseases, such as hepatitis and HIV, to be sure it is safe.

  • Drainage: Draining may be done to clean out any old blood or bile (brownish fluid) in your abdomen. This may need to be done more than once.

  • Embolization: This is done to stop bleeding from an injured blood vessel. After doing an angiography, caregivers block off the bleeding by injecting a liquid, coil, or gel into the vessel.

  • Surgery: Open or laparoscopic surgery may be done to repair the injured organ. Your caregiver may use sutures (threads) to close a cut. Omentum (fat connected to the bowels) may also be put to pack and close the cut in the organ. Bleeding vessels may be stopped by applying heat or closing them with sutures. Surgery to take out all or part of the spleen or liver may be done. Sometimes, surgery to correct other problems or treat other injuries may be done first. You may need to have more than one surgery.

  • Watchful waiting: If your condition is stable and your injury is mild, watchful waiting may be all that is needed. Your caregiver will watch you closely for a period of time until your liver or spleen injury heals on its own. You may need to rest in bed and limit your activity.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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