LIVER INJURY

LIVER INJURY

Liver injury, or hepatic trauma, may be blunt or penetrating in nature and is often associated with polytrauma. Causes can be understood through both Ayurvedic and modern perspectives.

AYURVEDIC VIEW

• According to Ayurveda, liver can be considered under the Yakrit organ, which is Rakta-pitta adhishthana and is Mamsa-ashaya sthita.

• Injury to Yakrit falls under Abhighataja Vikara, especially Kshata-Kshatabhagna mentioned in Sushruta Samhita.

• Causes of Yakrit injury:

  • Abhighata – direct trauma

  • Rakta-pitta dusti due to pitta vitiation

  • Pittaja Udara, Yakritodara, associated with chronic conditions

Modern Etiology (From Bailey & Love / Harrison's / Sabiston's Textbooks)

• Blunt trauma (e.g. road traffic accidents, falls, sports injuries)

• Penetrating trauma (e.g. stab wounds, gunshot injuries)

• Iatrogenic causes (e.g. liver biopsy, laparoscopic procedures)

• Spontaneous rupture in underlying hepatic pathologies like:

  • Hepatocellular carcinoma

  • Hemangioma

  • Echinococcal cyst

CLINICAL FEATURES

Ayurvedic Description

• Symptoms of Yakrit Abhighata align with those of Raktaja and Pittaja Vikara, and Kshata:

  • शोफः पीडाऽतिसारश्च रक्तपित्तं तथैव च ।
    यकृच्छूलं च यः कुर्यात् क्षतः स्यात्त्रिविधः स्मृतः ॥
    (Sushruta Samhita, Nidan Sthana 5/18)

  • Pain in right upper quadrant

  • Vomiting blood (if rakta is involved)

  • Fever, jaundice, or swelling in severe liver trauma

Modern Clinical Features

• Right upper abdominal pain/tenderness

• Signs of hypovolemic shock (e.g. tachycardia, hypotension)

• Distended abdomen due to hemoperitoneum

• Referred shoulder pain (Kehr’s sign)

• Signs of peritonitis in case of rupture

• Decreased hemoglobin due to internal bleeding

• Jaundice, in delayed presentation or associated bile leak

DIAGNOSIS

Ayurvedic Tools

• Darshana (Inspection) – observing deformity, swelling

• Sparshana (Palpation) – assessing pain, tenderness, mass

• Prashna (History) – trauma history, vitiated dosha involvement

• Associated with Yakritodara Lakshanas in Charaka Samhita:

  • दक्षिणपार्श्वे स्फुरणं शोथो रोमहर्षश्च विद्यते।
    स्नेहो न रोचते लोभो न तु स्यादन्नचेष्टिते॥
    (Charaka Samhita, Chikitsa Sthana 13/42)

Modern Diagnostic Tools

• Focused Assessment with Sonography in Trauma (FAST) – rapid detection of hemoperitoneum

• CT Scan (Contrast-enhanced) – gold standard for grading liver injury

• Diagnostic peritoneal lavage – in unstable patients without imaging

• Liver Function Tests (LFTs) – raised ALT/AST

• Hemoglobin & Hematocrit – to assess ongoing blood loss

• Angiography – in case of active bleeding requiring embolization

EMERGENCY MANAGEMENT

Ayurvedic Perspective

• Follows the principles of Abhighata Chikitsa and Raktastambhana

• Stambhana Chikitsa – to stop bleeding

• Shodhana / Raktamokshana is avoided in traumatic bleeding cases

• Tarpana, Brimhana Chikitsa for strengthening Yakrit

• Use of Rakta-pitta hara drugs:

  • Kamdugha Ras, Shatavari, Draksha, Madhuyashti, Musta

  • शस्त्राघातजविकारेषु स्रंस्ते रक्ता इहाचरेत् ।
    संज्ञाप्राप्तिः समुत्पत्तिर्मांसस्नेहादिभिः पुनः ॥
    (Sushruta Samhita, Sutra Sthana 24/10)

Modern Emergency Management

• Initial Resuscitation (ATLS Protocol)

  • Airway, Breathing, Circulation (ABC)

  • Large-bore IV access

  • Fluid resuscitation: crystalloids followed by blood products

  • Monitoring vitals, urine output, consciousness

• Non-operative Management (NOM) (preferred for stable patients)

  • ICU admission

  • Bed rest and monitoring

  • Serial abdominal exams and LFTs

  • Repeat imaging if condition worsens

  • Embolization if active bleeding is seen

• Surgical Management (for unstable patients or high-grade injuries)

  • Laparotomy with:

    • Perihepatic packing

    • Hepatorrhaphy (suturing liver lacerations)

    • Resection if needed

    • Pringle maneuver (to control hepatic bleeding)

• Post-op Care

  • Antibiotics to prevent infections

  • Nutrition and liver support

  • Regular LFTs and imaging follow-up