Liver

Hepatic trauma can result in massive hemorrhage and shock, or, if the capsule is intact (in blunt trauma), it can lead to subcapsular or intrahepatic hematoma. In a later phase, continuous expansion of this hematoma may cause sudden massive bleeding. Other sequelae are hemobilia and intra- or perihepatic abscesses caused by infection of devitalized tissue.

Furthermore, shock is associated with acute circulatory and metabolic disorders of the liver. The demand on liver function (e.g. for the metabolism of lactic acid) is increased during or following shock. Liver ischemia is associated with changes in glucose metabolism and decreased protein synthesis, leading to a decreased production of coagulation factors with subsequent coagulation disorders. In severe conditions, liver failure is seen as part of multiple organ failure, with hyperbilirubinemia and elevated liver enzymes. This is associated with a high mortality ( Haglund 1986).

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