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Abdominal injuries

Rupture of the spleen
The spleen is located in the upper left part of the abdomen , and its rupture is the most common cause of death among athletes with abdominal injuries. The injury may result from a direct blow to the abdomen, e.g. when a cyclist falls and the handlebar strikes the upper left part of the abdomen. Rupture can
also occur, albeit rarely, in cases of fractured ribs. It is important to remember that a ruptured spleen can result from any violent blow to the left side. Athletes who have had infectious mononucleosis (glandular fever) recently are more at risk.

Symptoms and diagnosis
A rupture of the spleen and its surrounding capsule causes bleeding into the abdominal cavity with ensuing pain, nausea, and tenderness and tenseness of the abdominal muscles. The injured person is at first affected only by pain, but after perhaps an hour signs of shock appear: a fast, weak pulse, sweating, paleness, and sometimes drowsiness or loss of consciousness. If the capsule remains intact, bleeding from the damaged organ will occur more slowly, with gradual distension and weakness of the capsule. There is then a risk that
rupture will be triggered by physical activity about 1–2 weeks after the initial injury; this occurs in 10–20% of cases.
If symptoms such as nausea, fatigue, or pain in the left upper abdomen or left shoulder tip persist after a blow, a doctor should be consulted.

The course of events and the results of the doctor’s examination and investigations will determine the length of stay in hospital. A CT scan and/or deep peritoneal lavage are helpful in confirming the diagnosis. Except
in severe cases, attempts are made to preserve the spleen because of its importance in the immune response; treatment includes rest, surgical suturing, and local coagulants, depending on the degree of injury. In severe
injuries the spleen is removed. Following splenectomy the patient should receive polyvalent pneumococcal vaccine and should be monitored closely for infection. Patients will have a lifelong impaired immune response

Rupture of the liver
The liver is located in the upper right-hand part of the abdomen below the rib cage . Its tissue is frail and it can rupture as a result of blows to this area. The injury occurs only rarely in sports, and most liver injuries are minor and self-limiting. Large ruptures can occur, however, causing shock with nausea, vomiting, lightheadedness, fainting, and drowsiness, with severe pain and distension of the abdomen. With any of these symptoms the athlete should be taken to hospital immediately. Almost all liver ruptures can be controlled with either rest and observation or surgery. A CT scan and/or deep peritoneal
lavage are useful diagnostic tools.

Major ruptures of the liver can also result in bile leaking into the abdominal cavity. This can be more of a problem than the bleeding, since chemical or bacterial peritonitis can occur, which can damage all the organs in the abdominal cavity. A careful evaluation with surgical inspection and repair of bile leaks is essential.

Kidney injuries
Kidney injuries in sports are rare. The kidneys are located above the pelvic girdle, one on each side of the spine. As a result of a violent impact to the flank, a kidney can rupture, causing blood to appear in the urine.
The bleeding often stops spontaneously and causes no further problems, but if disruption of a kidney is severe, and bleeding continues, surgery may be needed to repair or remove the kidney.

Blood in the urine after a blow to the kidney area should lead the athlete to seek medical advice.Diagnostic studies that can assist in assessing the degree of damage include CT and ultrasound scans, and intravenous pyelography.
After sustained, vigorous physical exertion without impact, a small amount of blood can appear in the urine, causing a faint red discoloration. This does not necessarily indicate a kidney injury, but should be investigated by a doctor.

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