Question

3. During practice, a women’s field hockey player was hit in the abdomen (right side) with an opponent’s stick. The athlete experiences immediate pain and discomfort. Upon evaluation the athlete complains of pain on her right side and slight discomfort in her right shoulder. Discomfort is located at ribs 8 through 12 in the intercostal spaces. Pain increases just below the diaphragm. After about 30 minutes of rest, the athlete begins to vomit and lose consciousness.

1. What are some indications of possible red flags?
2. What structures can be involved and in what region and quadrant are they located?
3. What pathologies would you rule out?
4. Does this athlete demonstrate any referred pain patterns? If so, explain.  
5. What do you think is wrong with this football player?

Answer 1

a) Intra-abdominal Hemorrhage : It is one of the important red flag in the abdominal injuries. Injury to the abdominal organ can result in severe bleeding . It is a emeegency condition , if you are suspecting a abdominal organ damage a CT or ultrasound scan should be done as early as possible. If there is a internal bleeding it should be stabilized by IV fluids and the underlying cause should be identified.

b) Structures involved can be

1)RIGHT LOBE OF LIVER (RIGHT HYPOCHONDRIUM)

2)RIGHT SIDE OF DIAPHRAGM(RT HYPOCHONDRIUM)

3)PANCREAS( RIGHT HYPOCHONDRIUM)

4)GALL BLADDER(RIGHT HYPOCONDRIUM)

5)RIGHT KIDNEY (RIGHT UPPER QUADRANT)

c)common pathology of the right hypochondrial pain that should be ruled out are

   a) HEPATITIS

   b)CHOLECYSTITIS

   c)PYELONEPHRITIS

   d)URETERIC COLIC

e)PANCREATITIS

D) Right shoulder pain is a referred pain

Injury to the liver, gall bladder, pancreas,right kidney can cause referred pain to the left shoulder. Because the nerve root suuplying the viscer have a dermatome suuply over the left shoulder.

e)This football most probably have a Blunt trauma to the Liver causing liver rupture.

Liver rupture result in severe internal bleeding. Due to the bleeding patient gone to hypovolemic shock and resulted in vomiting and loss of consciousness.