Snapshot A 33-year-old man is brought to a trauma center after a motor vehicle accident. He reports a lot of pain in his chest and his abdomen. Physical exam shows multiple rib fractures on the left side. His vitals show that he is hypotensive even after several liters of crystalloid fluids. A FAST exam shows free fluid in the perisplenic space. He is taken urgently into the operating room for an exploratory laparotomy. Introduction Overview splenic injury can result from trauma or nontraumatic causes treatment is usually surgical in a hemodynamically unstable patient Epidemiology risk factors diseases causing splenomegaly infectious mononucleosis dengue fever leukemia/lymphoma malaria malignancies penetrating trauma blunt trauma left-sided rib fracture Pathogenesis functions of the spleen helps fight infection by producing antibodies and other key immune mediators recycles old red blood cells stores platelets and white blood cells Presentation History trauma Symptoms common symptoms location left upper quadrant pain left shoulder pain (Kehr sign) diffuse abdominal pain Physical exam inspection abdominal bruising tachycardia hypotension shock provocative tests peritoneal signs guarding rigidity Imaging Abdominal ultrasound FAST exam focused abdominal sonography for trauma indications at bedside for all patients findings intra-abdominal free fluid CT of abdomen indications hemodynamically stable patients with history of blunt abdominal trauma to rule out splenic injury findings splenic bleeding splenic injury pseudoaneurysm Studies Serum labs may have anemia may have leukocytosis Differential Splenic abscess key distinguishing factor often in immunocompromised patients and IV drug users fever, leukocytosis, and left upper quadrant pain Treatment Medical close monitoring and serial abdominal exams indications hemodynamically stable patients Surgical exploratory laparotomy with possible splenectomy indications hemodynamically unstable complete rupture endovascular embolization indications hemodynamically stable incomplete rupture Complications Infection Acute respiratory distress syndrome Pancreatitis
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.GI.15.59) A 26-year-old man with no significant past medical history presents to the ED following a motor vehicle accident. Vital signs on presentation are T 99.0 F, BP 100/60 mmHg, HR 125 bpm, RR 16/min, SpO2 98% on room air. He complains of extreme abdominal pain worse in the left upper quadrant which has worsened over the past 30 minutes. Exam demonstrates abdominal wall rigidity, involuntary guarding, and tenderness on light percussion. Bedside sonography shows evidence for hemoperitoneum. Despite administering more intravenous fluids, repeat vitals are T 98.9 F, BP 82/50 mm hg, HR 180 bpm, RR 20/min, SpO2 97% on room air. Which of the following is the best next step? QID: 106394 Type & Select Correct Answer 1 Normal saline bolus and re-evaluation of hemodynamics after infusion 0% (0/18) 2 CT abdomen and pelvis 6% (1/18) 3 Morphine 0% (0/18) 4 Abdominal plain film 0% (0/18) 5 Exploratory laparotomy 89% (16/18) M 7 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept