As soon as wrestler is mentioned to me, possibilities going through my mind include sports related injury, splenic rupture, testosterone abuse or steroid abuse, excessive protein intake side effects, contact sports related problems for instance transmission of fungal infections, .
Abdo pain for 1 day. Started after wrestling. As soon as this is mentioned to me, I start thinking of splenic rupture because this patient might have had infectious mononucleosis - which in its second week causes splenomegaly and a very soft and fragile spleen which is prone to being ruptured with any type of contact sport.Having damage done to the kidney or liver is also a possibility but less likely. The differential diagnoses of abdominal pain by itself are countless.
LUQ As soon as I'm told it is in the left upper quadrant, it's almost confirms that this would be a splenic rupture or peptic ulcer disease or a rib fracture.
Peptic ulcer and also rib fracture typically do not give pain in the shoulder when the patient is placed in head low position but splenic rupture does do this because the blood gravitates towards the diaphragm which has the same nerve innervation as the left shoulder region and thus there is pain in that region.
Had fever earlier and has a PMH IM. Now the diagnosis is almost certain. Splenic rupture it is and this makes it a medical emergency. The surgical consult must be called. A CT scan of the abdomen and reveal free fluid in the peritoneum.
Postural Hypotension. Splenic rupture. The patient needs to be given IV fluids immediately blood knees to be sent for type and cross match immediately six units of blood should be kept ready. The patient should be monitored in the intensive care unit. Informing the family is critical.
Now to tackle the other problems mentioned
in the first paragraph - just in case the scenario is changed in the exam. Testosterone abuse can lead to
liver failure and hair loss. Liver failure with testosterone can be fulminant as opposed
to liver damage that takes place with estrogen which is usually a slow process.
Steroid abuse, Androgenic steroids can also cause liver damage.
Excessive protein intake can cause muscle damage and raised creatinine. Remember that many
athletes supplement with pure amino acids and one of the problems with this can be caused
due to Tryptophan - eosinophilic myositis.
Sports related injury like shin splints due to running or rib fracture or lumbar sprain
etc.
Contact sports related problems for
instance transmission of fungal infections. Tinea
corporis that is resistant to treatment due to repeated cross transmission.
| Differential Diagnoses include: 1. Splenic rupture 2. Perforated peptic ulcer 3. Rib fracture 4. Splenic infarct (Seen in sickle cell disease) 5. Muscular injury 6. Keoacidosis (can give pain anywhere in the abdomen) 7. Kidney stone 8. Illicit drug use (cocaine) |
Investigations include: 1. CT scan of the abdomen 2. Erect Chest X-ray with abdominal series 3. Rib X-rays 4. Urinalysis 5. DPL (Diagnostic peritoneal lavage) It is done in the ER itself. 6. Ultrasound of abdomen (look for free fluid in peritoneum or hematoma near the spleen) 7. Monospot test 8. CBC/CMP 9. Type and cross 2-4 units of blood. 10. EKG (Cocaine related splenic infarct/MI) 11. UDS (Urine drug screen) |