determine
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A 9-year-old boy is brought to the hospital with a history of having fallen from his bike. He fainted and is now complaining of abdominal pain and thirst. There is general abdominal tenderness and rebound tenderness. Approximately 4 hours after the accident, the white blood count is 20 x 109/L and the hemoglobin is 80 g/L. What is the most likely diagnosis?
1) renal contusion
2) acute pancreatitis
3) ruptured spleen
4) retroperitoneal hematoma
5) ruptured bowel
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| babli
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3) ruptured spleen
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| achilles
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3-ruptured spleen
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| mesh
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why not 5......in ruptured spleen why Hb will be elevated......
i think its due to hemoconcentration...patient is hypovolemic....fluid loss from the gut...
correct me if wrong......
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| Rasul
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I don't see how Hb can be elevated in any of mentioned options(maybe except renal contusion, although it's a big stretch...contusion, and as a result erythropoetin overproduction?..don't think I've ever heard of smth like that). It's possible it's just a mistake and authors meant 8g/L, or 80 g/dL.
He's thursy coz he's bleeding.
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| achilles
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well guys...its 80g/L and not 80g/dl ...so the Hb is not elevated it is actually low...and ruptured spleen is the most common injury resulting in internal hemorrhage.
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| Rasul
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Sorry, clarification to my answer: Imeant 8 g/dl(normal values 12-16 g/dl)Agree, It's ruptured spleen, internal bleeding
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| achilles
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i know these values can get you mixed up when the units are different. i got mixed up myself a couple of times and you were right about the internal bleeding rasul.
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| determine
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answer is 3
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| AAAAA
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I have to think and look this up.
Ruptured bowel is not possible because the first part of the bowel duodenum will be rutpured but then you will have free air under the diaphargm.
They should give you the free air.
Go for the simple things
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| AAAAA
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This is the IU International unit
80g/L = 8.0 g/dL
80g/L is used throughout the world and 8.0 g/dL is only used in US
80g/L or 8.0 g/dL indicates massive bleeding.
Why rutpured bowel is NOT impossible?
Think like a doctor, walk like a doctor, talk like a doctor !!
Can duodenum such a vascular structure you can lose all that blood ? Hell no ! NO
The only way to lose that much blood is GSW gun shot wound to the abdomen with a vascular structure and spleen definitely is a vascular structure
Spleen rutpure you can lose 20% of all the blood in 30 minutes
Think in the real world !
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| AAAAA
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Also rupture AAA can cause you to lose massive amt of blood and hypotensive
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