Introduction:
Hepatic hemorrhage or liver hemorrhage happens due to a rupture in the functional cells of the liver (hepatic parenchymal cells) or hepatic tumors without any injury or trauma due to an external force. If not treated early, this will lead to bleeding in the abdomen, shock, and death. It is due to a rupture in the underlying hepatic tumor (abnormal growth of liver cells) or hepatic adenoma (non-cancerous liver tumor) and cirrhosis (scarring of the liver).
Symptoms of a bleeding liver are pain in the right upper region above the stomach, vomiting blood, low blood pressure, high heart rate, blood in stools, lightheadedness, and shock in severe cases. Abdominal ultrasound, CT scan, and MRI are the methods used to diagnose the condition. Treatment includes liver resection (surgical removal of a part of the liver or whole liver) and embolization (blocking a blood vessel with the help of tiny gelatin sponges to stop bleeding).
What Is Hemorrhage of the Liver?
Hemorrhage of the liver is too much bleeding in the liver. It is a rare complication that leads to death if left untreated. Liver hemorrhage can be due to an external injury or spontaneous hemorrhage due to an underlying lesion or condition.
What Are the Causes of Liver Hemorrhage?
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External Injury: External injury by car accidents, direct blows to the stomach during a fight or while playing sports activities, and accidental falls can injure the stomach. This leads to minor or major damage to the blood vessels and causes bleeding.
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Spontaneous Hemorrhage: Spontaneous hemorrhage in the liver can be due to the rupture of an underlying tumor or a liver disease like cirrhosis.
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Cirrhosis: Cirrhosis is a severe liver disease that involves the replacement of healthy liver tissues with scar tissues. This hardens the liver and does not function properly. This leads to slow blood supply and increased pressure in the portal vein. A portal vein is a blood vessel that carries blood from the spleen, gallbladder, and gastrointestinal tract to the liver. When there is increased pressure in the portal vein, there is a rupture of the vessels, and this leads to bleeding.
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Hepatocellular Carcinoma: Hepatocellular carcinoma (a cancerous liver tumor) causes hepatic bleeding. Though the exact reasons are unclear, some investigators suggest the bleeding may be due to minor lacerations on the tumor, due to a small external injury, or internally due to repeated respiratory movements. Also, due to rupture of the blood vessels that supply the tumor, or as a result of rupture of the vessels as the pressure is increased due to cancer spreading deeper. Patients with a large size tumor in the liver projecting into the abdomen rupture and result in bleeding.
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Hepatocellular Adenoma: Hepatocellular adenoma is seen in women who have taken oral contraceptive pills for a long time. This is a benign tumor, it ruptures, and the bleeding is limited. However, this bleeding can sometimes be severe and result in shock.
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Hepatic Hemangioma: Hepatic hemangioma is the most common benign liver tumor. They are common in women. They are generally small, less than 3 cm (centimeter), and do not show symptoms. However, when the size of the tumor is more than 4 cm, it is large. Large hemangiomas tend to rupture and cause bleeding.
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Rupture: Rupture of metastasis from the primary tumor of the lungs, stomach, breast, pancreas, or testicle causes bleeding. The bleeding in the liver is common with lung cancer, kidney cancer, and melanoma (skin cancer).
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HELLP: HELLP (hemolysis, elevated liver enzyme, low platelet count) is a serious condition in pregnant women. It occurs in the third trimester of pregnancy. This occurs immediately after birth and leads to intravascular coagulation (which forms clots inside the blood vessels), hepatic necrosis (death of liver cells), and hemorrhagic infarction (bleeding inside and dying cerebral tissue). The series of shock episodes leads to hepatic hemorrhage, and it is life-threatening.
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Amyloidosis: Amyloidosis is the extracellular deposition of the fibrous protein amyloid in one or more areas of the body. This causes spontaneous rupture due to enlarged liver and results in bleeding. This is a fatal condition where death happens within a few hours to days.
What Are the Symptoms of Hepatic Hemorrhage?
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Vomiting blood.
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Lightheadedness.
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Pain in the right upper region above the stomach.
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Blood in stool.
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High heart rate.
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Low blood pressure.
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Shock (when the blood flow is dropped suddenly throughout the body).
How Is the Hepatic Hemorrhage Found?
Though other imaging techniques are used in the diagnosis of hepatic hemorrhage, a CT scan is the best way to find out the origin of the bleeding site.
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Ultrasound: Ultrasound is an imaging technique that uses high-frequency sound waves to capture the image of the internal organs.
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Computed Tomography (CT) Scan: This imaging technique captures X-rays with the help of a computer at different angles. This is the best way to diagnose hepatic hemorrhage.
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Magnetic Resonance Imaging (MRI) Scan: This imaging technique uses a combination of high-frequency radio waves in a magnetic field to capture images of internal organs. This gives a detailed image of the internal structures and tissues of the body.
How Is Hepatic Hemorrhage Treated?
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Trauma Due to External Force:
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Fluid therapy through the intravenous route is started first.
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Then, when there is moderate blood loss, blood transfusions are done.
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Finally, surgical procedures are done to remove the fluids and blood from the stomach region.
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Placing stents (a tubular structure), using rubber bands to stop the bleeding vessel, and blood clotting solutions are injected to arrest bleeding.
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Spontaneous Hemorrhage:
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Transcatheter arterial embolization: It is a procedure done to obstruct and stop the blood supply to a tumor. This procedure involves a small incision made in the inner thigh, and a small tube (catheter) is guided to the artery that supplies blood to the tumor and is placed. Next, a sterile spongy substance called Gelfoam is injected. This absorbs the blood and stops further bleeding.
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Removal of the ruptured tumor along with a margin of normal liver.
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Artery ligation is a surgical procedure that involves suturing or tying a thread around the vessel that causes bleeding.
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Treatment depends on the size, rate of bleeding, and location of the tumor in case of hepatic metastasis. Usually, the prognosis is poor, where the patient lives less than six weeks or less than six months.
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In HELLP, immediate delivery of the baby and embolization of the artery that causes bleeding are done.
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Who Is at Risk for Hepatic Hemorrhage?
People with chronic liver diseases like cirrhosis and liver lesions, both cancerous and non-cancerous, are at risk.
Can Liver Hemorrhage Be Prevented?
External injuriescan be prevented by being careful and avoiding accidents or petty fights. However, spontaneous liver hemorrhage cannot be prevented or predicted.
What Are the Complications of Liver Hemorrhage?
When bleeding is not detected or controlled early, the person may go into shock and die. In addition, there are other serious complications like liver failure, kidney failure, infections, confusion, and coma results even after controlling bleeding.
Conclusion:
Hepatic hemorrhage due to external trauma or injury can be easy to diagnose and treat. In severe cases, hospital care and blood transfusions may be needed. In spontaneous hepatic hemorrhage, it is difficult to find the cause, and treatment is complicated in some cases. It may lead to shock and death of the patient. Though this is a serious life-threatening condition, it is rare.
