[chetnarayan]

Case study...JULY 6th



BACKGROUND
A father brings his 15-year-old son to the emergency department because of a large bruise over the son's lower left ribs from being struck by a lacrosse ball during an inter–high school game. In addition to complaining of pain in the upper portion of his left abdomen, the patient also has pain in his left shoulder, which movement seems to aggravate. He is ambulatory and in no acute distress.

The triage nurse orders a chest radiograph, which is normal. The patient is triaged to fast-track care.

On physical examination, the patient has a blood pressure of 125/78 mm Hg, a heart rate of 106 beats per minute, and a respiratory rate of 12 breaths per minute. His temperature and oxygen saturation are normal. He has no trouble walking, but he seems to have a lot of pain while positioning himself on the bed. Findings from cardiorespiratory examination are unremarkable. He has diffuse abdominal tenderness that is most pronounced in the left upper quadrant. No rebound or guarding is observed. The patient has no tenderness to palpation over the left shoulder or clavicle, and he has full range of motion in that joint.

What is the diagnosis?[/




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