What are Liver Injuries?
Because of its size, the liver is the most easily injured abdominal organ in children. Located in the upper-right area of the abdomen. Most liver injuries are caused by blunt trauma from a car crash, fall, bike wreck or any other activity that causes a hard blow to the abdomen. A penetrating liver injury may also result from a gunshot wound or sharp object that tears or cuts the liver.
What is the Function of the Liver?
The liver is the largest solid organ in the body and is necessary for survival. The liver has many jobs; it:
- makes bile, which helps with digestion
- filters and cleans the blood and helps remove bacteria
- stores carbohydrates, vitamins and minerals
- makes proteins, glucose and clotting factors
- breaks down hormones and certain drugs
How is Liver Injury Diagnosed?
Most children with liver injuries will have abdominal pain after the trauma or injury.
If a liver injury is suspected, the trauma surgery providers will thoroughly and carefully examine your child. X-rays, a computed tomography (CT) scan, ultrasound or blood tests may be done.
The American Association for the Surgery of Trauma (AAST) grades liver injuries on a scale of 1-5. The grade is determined by the size and location of the injury seen on a CT scan. Grade 1 is the least severe and 5 is the most severe.
How are Liver Injuries Treated?
Children with grades 1 or 2 liver injuries may be discharged from the Emergency Department or admitted to the hospital. Children with grades 3-5 liver injuries will be admitted to the general care unit or to the intensive care unit (ICU) for pain management, blood tests and close monitoring. Most liver injuries are treated without surgery.
Depending on the grade of injury, treatment can include strict bed rest, nothing to eat or drink for a short period of time, pain control, lab tests, and IV fluid hydration. Sometimes blood transfusions are necessary.
If bleeding from the liver does not stop on its own, surgery to fix the damage and stop bleeding may be needed.
If your child has surgery, they will not be allowed to eat after surgery for some time. However, they will be given an IV (a small tube in their vein) for fluid hydration. Your child may also have a nasogastric tube (a tube through the nose into the stomach) after surgery to keep their stomach empty.
Medications and Pain Management
Speak to your trauma surgery provider about medicines your child was taking before they were admitted to the hospital. They will let you know when it is okay to restart any home medications. Your child may have some pain or soreness at home. Give acetaminophen (Tylenol®) for pain.
Your child's trauma surgery provider may also write a prescription for stronger pain medication. Give the stronger medication if the pain does not go away one hour after giving acetaminophen. Follow the directions on the prescription.
Do not give your child NSAIDs or ibuprofen (also known as Motrin®, Advil®, Aleve®, etc.) until the trauma surgery provider says that it is okay. Your child may require a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements.
Wound and Skin Care
Your child may shower or take a bath, but they may need help for several days after going home. If your child has had surgery, check with your trauma surgery provider about taking a shower or bath.
Follow instructions given by the trauma surgery provider regarding any other injuries or wounds.
If your child has cuts or scrapes on the skin from other injuries, wash the areas with warm, soapy water and pat dry.
Activity After a Liver Injury
Your child does not need to stay in bed but should walk and play quietly while they heal. Your child should not rough play with family, friends or pets for several weeks. They may return to school in two to seven days, but your child will be on strict activity restrictions for some time. Strict activity restrictions include no gym, running, activities with wheels, or any activity in which both feet leave the ground at the same time. Your child should also not participate in any competitive/contact sports until the activity restriction time period is complete. The length of activity restrictions will depend on the grade of the liver injury.
Returning to Daycare or School
Your child may require some time off school to be at home to rest. Your trauma surgery provider will give you recommendations regarding going back to school. If surgery was needed or your child has other injuries, they may be out of school longer. At school, your child should not be taking gym class until the activity restriction time period is complete.
Once it is okay for your child to return to normal activity, no further follow-up will be needed. After your child has healed, they are not at an increased risk to hurt their liver again.
When to Call Your Trauma Surgery Provider
Call the trauma clinic or seek medical attention if your child has:
- Increased or worsening abdominal pain
- Fever higher than 100.5°
- Difficulty with bowel movements
- Shortness of breath
- Nausea / vomiting
- Dizziness
- A fast heart rate
- Redness, swelling, pus drainage, or increased pain around the wound
Emotional Recovery
After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities. Have your child play board games, read or do small craft projects for short periods of time. Infants and toddlers are harder to distract and will be more difficult to confine but avoid high-risk activities such as wheeled activities or using jungle gyms.
After any trauma, children may experience acute stress symptoms. If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms, please speak with the trauma surgery provider. Short-term therapy can be provided to help children heal and recover emotionally after a trauma.
Preventive Action
It’s important to teach your child about all types of safety. Unintentional injury is one of the leading causes of death for children in the United States.
At Home: If you have guns in the home, they should be unloaded and locked with a locking device with ammunition stored separately.
At Play: Make sure your child wears the correct type of helmet when riding a bike, using other wheeled toys, or taking part in sports that require helmets.
On the Go: Make sure your child is secured in an age-appropriate child restraint every time they ride in a vehicle. Children under 13 years should not ride in the front seat.
