A 19-year-old football player was accidently kicked on the left side of his chest. On returning to the locker room he said he felt faint and collapsed to the floor. On examination in the emergency department, he was found to be in hypovolemic shock. He had tenderness and guarding in the left upper quadrant of his abdomen. He also had extreme local tenderness over his left tenth rib in the midaxillary line. A diagnosis of a ruptured spleen and the possibility of a fractured tenth rib was made. Explain the tenderness and guarding in the abdomen in this patient.

Question

Quizplus · Accepted Answer

The Answer is Initially in this patient, the spleen underwent a subcapsular hemorrhage, and later, in the locker room, the capsule gave way, allowing the blood to
escape into the peritoneal cavity. The presence of blood in the peritoneal cavity irritated the parietal peritoneum, causing tenderness in the left upper
quadrant and reflex guarding of the muscles in the same area.

A 19-Year-Old Football Player Was Accidently Kicked on the Left