Your liver is a large, wedge-shaped organ that sits just below your rib cage and lungs. It’s vital for filtering toxins from your blood, creating bile to digest fats, and making substances that help your blood to clot.

Your liver holds approximately 1 pint of your body’s blood at any given moment. Due to its size and location, it’s also one of the most injured organs in your body, especially when it comes to blunt force trauma.

Keep reading to find out more about the injuries that can arise from a blow or punch to your liver and how they’re usually treated.

Your liver is located just under your diaphragm, on the right side of your abdomen. It’s the largest internal organ in your body.

Due to its relatively large size and location in the front of your body, it’s vulnerable to injury, especially if you receive a blow to your abdomen.

There are a number of common trauma causes that may result in injury to the liver. Examples of blunt force trauma include:

  • a blow or punch to the stomach area
  • motor vehicle accidents
  • pedestrian accidents
  • a fall
  • trauma due to a gunshot or stab wound
  • industrial or farming accidents

If you experience blunt force trauma to your liver, it may result in one or more of the following types of injuries:

  • hematoma, which develops when the wall of a blood vessel is injured, resulting in a collection of blood outside a blood vessel
  • laceration (tear) to the liver, which can be shallow and cause no bleeding, or it can be deep and cause heavy bleeding
  • loss of blood supply to the liver

Liver injury categories

The American Association of Surgery for Trauma divides liver injuries into six types of categories, or grades. These provide a quick reference to help identify how severe a liver injury is. The higher the grade, the more severe the liver injury.

For instance, grade 1 injuries typically include either:

  • a hematoma that takes up less than 10 centimeters of the liver’s surface area and isn’t spreading or getting bigger
  • a laceration that’s less than 1 centimeter deep and isn’t bleeding

On the other hand, grade 5 or 6 injuries are much more severe and may include:

  • injuries to the liver’s major veins that cause heavy bleeding
  • a deep laceration that disrupts large sections of the liver
  • loss of blood supply to the liver

Fortunately, an estimated 80 to 90 percent of people who experience a blow to the liver experience grade 1 to grade 2 injuries. Doctors can usually treat these with nonsurgical interventions.

In some cases, especially for injuries that fall into higher categories, damage to the liver can be fatal.

If you experience any kind of trauma, such as a car accident, fall, or blow to the abdomen, it’s vitally important to get emergency medical attention.

Even if you aren’t in pain or don’t feel like you have any injuries, you may still have internal injuries.

A blow to your liver can cause bleeding you may not see or feel. After a while, the bleeding can start to affect how you feel, and your blood pressure can drop quickly. If you seek treatment as soon as possible, doctors can work to prevent this from happening.

Even if you think a blow to your liver didn’t cause any damage, there are signs to watch out for. If you have any of the following symptoms, get immediate medical attention:

If the blow to your liver wasn’t too severe, you may still feel some tenderness or minor pain, usually under your ribs.

To diagnose a liver injury, doctors usually use a combination of imaging and blood tests as well as a physical exam.

If you go to the emergency room or your primary doctor’s office after experiencing a blow to the liver, they may use some or all of the following tests:

  • Ultrasound. This is a fast, painless imaging test that uses ultrasound waves to determine whether there’s active or significant bleeding in the liver.
  • CT scan. A CT scan is a painless imaging exam that can create images of the inside of your liver. This helps your doctor see how severe a liver injury is and if there’s damage to the deeper parts of your liver.
  • Angiogram. An angiogram, also known as an arteriogram, produces images of your arteries. Your doctor will use contrast material or dye, given through an IV, to look at the flow of blood. It can tell your doctor if blood is escaping through tears in the walls of the blood vessels in your liver. Ideally, your doctor can use these images to identify and stop the bleeding.
  • Blood tests. Your doctor can draw blood from a vein and test it to make sure your liver chemistry is healthy. This type of test can show whether you have the right levels of liver enzymes, proteins, and bilirubin in your blood. It can also tell if you have lost a significant amount of blood or have enough of the compounds you need to help your blood to clot.

Doctors can quickly perform most of these tests to determine whether there’s any damage to the liver and how severe it is. If you have other injuries, your doctor may use these and other tests to diagnose those injuries too.

Severe injuries from a blow or punch to the liver may need to be treated with surgery or angioembolization.

Angioembolization involves sealing off bleeding vessels in the liver to stop blood loss. According to a 2011 review of research, angioembolization is the “gold standard” to manage liver injuries and control bleeding.

For minor blows to the liver, time and close monitoring are the treatments doctors usually recommend.

Thanks to advancements in imaging and treatment, your doctor or healthcare team can watch you carefully to make sure you don’t seem to be losing blood and maintain your blood pressure.

While you’re being monitored, you’ll likely need to give frequent blood samples. If you’ve lost a lot of blood, your doctor may recommend a blood transfusion. Or they may suggest transfusing certain blood compounds that help your blood to clot.

A blow to the liver can leave you feeling tender and sore. If your doctor recommends managing your injury at home, here are some steps you can take to help your recovery:

  • Rest. Getting plenty of rest allows your body and your liver to recover. It also reduces the risk of hurting your liver again.
  • Avoid alcohol. Your liver breaks down any alcohol that you drink. If you’ve injured your liver, not drinking alcohol puts less strain on your liver.
  • Limit nonprescription medications. Your liver is responsible for breaking down many medications, including acetaminophen (Tylenol). Ask your doctor what medications you should avoid or limit while your liver heals.

Seek emergency medical attention if you experience any of the following symptoms while recovering:

  • shortness of breath
  • severe abdominal pain
  • rapid heart rate
  • dizziness

The size, positioning, and amount of blood vessels in your liver make it vulnerable to injury and bleeding due to blunt force trauma.

Depending on the severity of the force, trauma to the liver can cause injuries that range from minor to potentially life threatening.

In some cases, you may not feel pain, or know that you’re bleeding internally. That’s why it’s important to seek medical treatment if you’ve had a blow to the liver.

Getting the right medical care as quickly as possible can help minimize potential complications.