What is the recommended treatment and recovery plan for a patient with liver injury, including rest, medication, and diet?

Adequate Rest and Recovery After Liver Injury

Mobilization and Physical Activity

Early mobilization should be encouraged in stable patients from the first day after injury, with no evidence that early movement causes non-operative management failure or secondary bleeding. 1

• Patients with stable hemodynamics can begin daily walking immediately without risk of complications 1, 2
• Early mobilization is not associated with increased bleeding risk or treatment failure in hemodynamically stable patients 1
• Bed rest beyond initial stabilization is associated with harmful effects including muscle atrophy, thromboembolism, and insulin resistance 1

Return to Normal Physical Activities

After moderate and severe liver injuries (grades III-V), patients may resume normal physical activities after 3-4 months, as the majority of liver lesions heal completely within this timeframe. 1

• Minor injuries (grades I-II) typically heal faster, with sonographic normalization occurring in a median of 30 days for grade II injuries 3
• Grade III injuries show complete healing in approximately 63 days (median), with 75% recovered by 80 days 3
• Grade IV injuries require approximately 62-98 days for complete healing, with 75% recovered by 98 days 3
• Grade V injuries may require up to 118 days for complete parenchymal normalization 3

Thromboprophylaxis Timing

LMWH-based thromboprophylaxis should be initiated within 48-72 hours after injury in stable patients, as VTE rates increase over fourfold when delayed beyond 72 hours. 1, 2

• Mechanical prophylaxis (sequential compression devices) should be considered immediately in all patients without absolute contraindications 1
• No differences in complications, mortality, or non-operative management failure were demonstrated when thromboprophylaxis was administered within 48-72 hours versus later 1
• Venous thromboembolism is the third leading cause of death in trauma patients, with over 50% developing deep vein thrombosis without prophylaxis 1, 2

Nutritional Management

Enteral feeding should be started within 72 hours of admission in the absence of contraindications, as early nutrition is associated with improved clinical outcomes. 1

• Oral intake should be initiated after 24-48 hours from the traumatic event when possible 1
• Contraindications to early feeding include: uncontrolled shock, vasopressor therapy, uncontrolled hypoxemia and acidosis, uncontrolled upper GI bleeding, gastric aspirate >500 ml/6 hours, bowel ischemia, bowel obstruction, abdominal compartment syndrome, and high-output fistula 1
• Early enteral feeding within 72 hours in ICU patients improves outcomes 1

Activity Restrictions and Monitoring

Patients should avoid remaining alone for long periods during recovery and must return immediately to the hospital for increasing abdominal pain, lightheadedness, nausea, or vomiting. 1, 2

• No mandatory late follow-up imaging is required unless clinical condition or new symptoms develop 1
• Routine imaging surveillance is not indicated; imaging should be symptom-driven only 1
• Patients should be counseled on warning signs requiring immediate return: worsening abdominal pain, lightheadedness, repeated vomiting, or new neurological symptoms 1, 2

Common Pitfalls to Avoid

Do not prescribe prolonged strict bed rest beyond initial stabilization, as this causes more harm than benefit through deconditioning and thrombotic complications. 1

• Avoid delaying thromboprophylaxis beyond 72 hours, as this dramatically increases VTE risk 1, 2
• Do not restrict early mobilization in stable patients, as movement does not increase bleeding risk 1
• Avoid routine follow-up imaging in asymptomatic patients, as it provides no clinical benefit and increases healthcare costs 1
• Do not delay enteral nutrition beyond 72 hours without specific contraindications 1