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.

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 a liver injury. Examples of blunt force trauma include:

  • a blow 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 World Society of Emergency Surgery divides liver injuries into four 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.

Grade 1 or 2 injuriesGrade 3 or 4 injuries
hematoma takes up less than 10 cm of liver and isn’t spreadinginjuries to liver’s veins cause heavy bleeding
laceration is less than 1 cm deep and isn’t bleedinglaceration is deep and disrupts sections of the liver
blood circulation is considered stableloss of blood supply to the liver
blood circulation is considered unstable

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 nonsurgically.

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

Seeing as the organ is within the body, it may be hard to identify symptoms. There are a few markers that may show that your liver has been bruised or damaged. These can include:

It’s worth noting that symptoms of a bruised liver can be different based on the level of trauma. If the bruising wasn’t too severe, you may still feel some tenderness or minor pain, usually under your ribs.

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 bruised 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 get treatment as soon as possible, doctors can work to prevent this from happening.

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. It can also identify pooling of blood that may occur in the abdomen due to a liver injury.
  • 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 intravenous (IV) line, 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’ve 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.

Treatment for a bruised liver can differ depending on how severe the injury is, and the level of symptoms you’re experiencing.

Mild injuries

According to recent guidelines, nonoperative management should be considered the standard treatment for all grades of liver bruising when surgery isn’t necessary. These nonoperative measures can include angioembolization or angiography, which are minimally invasive procedures where physicians use imaging to help close arteries that are losing too much blood.

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

Moderate to severe injuries

Severe injuries from a bruised liver may need to be treated with surgery to stop hemorrhaging and control any further damage that may happen to the liver.

Angioembolization can also be used in cases of severe or moderate injuries in order to control bleeding even after physicians have attempted to control or monitor bleeding.

Another treatment that can be helpful in managing possible hemorrhaging is through a resuscitative endovascular balloon, which is placed in the aorta to control bleeding.

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. They may also 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 lowers 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.

Call 911 or local emergency services 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 get medical treatment if you’ve had any kind of trauma to the right upper abdomen or right lower chest wall, where your liver is located.

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