Adam II: Rugby Collapse

Gastrointestinal System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S27_F1.jpg"}},{"insert":"\n\n"},{"insert":"Not long ago, you treated 15-year-old high-schooler and rugby team captain Adam McGlynn for infectious mononucleosis. You cleared him to attend school, but asked that he avoid contact sports for four weeks.\n\nUnfortunately, boys will be boys. Just three weeks later, Adam is brought to the ED, accompanied by his coach. Apparently, he started rugby practice yesterday, after informing his coach that it was \u0022safe for him to practice now.\u0022\n"}]}


{"ops":[{"insert":"The coach says that Adam collapsed mid-game 20 minutes ago. He complained of dyspnea and pain over the left side of his abdomen and was rushed to hospital.\n\nAdam describes a throbbing continuous 5\/10 pain in the left flank that radiates to the mid-epigastrium. He also tells you he feels sharp pain in his left shoulder.\n\nYou recall that he has no chronic illnesses, is not on any medications, is fully immunized, has no allergies, and doesn\u2019t drink alcohol, smoke or take drugs.\n\nOn examination, his temperature is 37.6 \u00b0C, blood pressure is 100\/70 mmHg, pulse is 80 bpm and respiratory rate is 25\/min. His oxygen saturation is 95% on room air.\n\nNo external injuries are present. There is no evidence of rib or spinal fractures. On deep palpation, there is localized tenderness just below the left costal margin. No other untoward findings are present.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S27_F3.jpg"}},{"insert":"\n\n"},{"insert":"You obtain IV access, and order a panel of investigations. A short while later, the results are in front of you:\n\nRBC: 3.85 x 10\u2076\/\u00b5L (3.80-5.20)\r\nWBC: 10,400\/mm3 (4,300-10,800)\r\nHb: 10.5 g\/dL (13.5-17.5)\r\nHct: 28% (33-44)\r\nMCV: 80 fL (76-96)\r\nMCH: 30 pg (27-32)\r\nPlatelets: 120,000\/mm3 (150,000-450,000)\r\nESR: 108 mm\/hr (0-22)\n\nALT: 60 U\/L (7-55) \r\nAST: 73 U\/L (8-48) \r\nALP: 90 U\/L (45-115)\r\nGGT: 11 U\/L (9-48)\r\nAlbumin: 4.1 g\/dL (3.5-5.0)\r\nTotal protein: 6.6 g\/dL (6.3-7.9)\r\nBilirubin: 1.0 mg\/dL (0.1-1.2)\r\nLDH: 200 U\/L (122-222) \r\nPT: 11 seconds (9.5-13.8)\n\nBUN: 12 mg\/dL (3-20)\r\nCreatinine: 1.0 mg\/dL (0.6 - 1.2)\n"}]}