Liver, residuals of injury of the liver. The liver is the largest organ in the body and is situated on the right side under the diaphragm. The liver secretes bile and has many metabolic functions. Because of its size and location in the abdomen, it is subjected to blunt and penetrating injuries. The term injury is usually applied to damage by an external force, and may not be visible from the outside.

The liver may be injured by blunt trauma from automobile accidents, falls from heights, or sporting events. Penetrating injuries may result from stab or gunshot wounds.

Signs and symptoms may vary with the nature, type and extent of injury (e.g., pain may be absent in severe injuries). Manifestations of blunt injury to the abdominal area include severe pain radiating beyond the abdomen and into the shoulders; bruises, abrasions, and contusions; nausea and vomiting; pallor; cyanosis; tachycardia; or dyspnea. Indications of penetrating liver injuries include blood loss; pain and tenderness; and, possibly, pallor, cyanosis, diaphoresis, tachycardia, dyspnea, and hypotension.

Diagnostic measures for this condition may include: abdominal x-rays; computed tomography (CT) scan; magnetic resonance imaging (MRI); ultrasonography; and laboratory examinations to measure possible blood loss, and liver enzymes.

Treatment will depend on the extent, type, and location of the injury. Possible emergency treatment will be required for hemorrhage and shock. Penetrating wounds may require surgical repair or partial removal of the liver. Blunt injury to the liver may require hospital monitoring and observation for 24 hours or longer.

Residuals from blunt injury may result in impaired liver function and require long-term follow-up care. Up to 80% of the liver can be resected in trauma cases and be tolerated if normal liver function was present prior to injury. However, liver surgery may be followed by some residual liver abnormalities.

• None.

• Depending on the specific residuals, separately evaluate as adhesions of peritoneum (diagnostic code 7301), cirrhosis of liver (diagnostic code 7312), and chronic liver disease without cirrhosis (diagnostic code 7345).

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.