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Harry Perelman, M.D.; Harold R. Sherwood, M.D.
JAMA. 1960;173(9):1019-1020. doi:10.1001/jama.1960.73020270006010c.
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On examination of any victim of an automobile accident, the possibility of injury to the liver and bile ducts should be considered, especially in the presence of a rib fracture on the right side of the thorax. Tenderness on compression of the lower portion of the rib cage on the right side plus pain referred to the right shoulder in the absence of rib fracture, in a patient after an automobile accident, are ample evidence for the diagnosis of rupture or laceration of the right lobe of the liver.1

Signs and Symptoms  In cases of ruptured liver, those victims who are not killed immediately show the signs and symptoms of intraperitoneal hemorrhage, including pain, weakness, pallor, restlessness, dyspnea, rapid pulse, fall in blood pressure, shifting dulness, subnormal temperature, anemia, leukocytosis, abdominal tenderness and rigidity, and absent or decreased bowel sounds. The escape of blood and bile into the peritoneal


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