Which findings suggest splenic injury in blunt abdominal trauma?

• A. Tender left upper quadrant, referred left shoulder pain (Kehr's sign), hypotension/shock, positive FAST.
• B. Tender right upper quadrant with Murphy sign.
• C. Lower abdominal tenderness with positive FAST.
• D. Neck stiffness and photophobia.

Answer: (A)

In blunt abdominal trauma, a splenic injury is most suggested when there’s tenderness in the left upper quadrant with a sign of diaphragmatic irritation and evidence of intra-abdominal bleeding. Tender LUQ localizes pain to the spleen, while referred left shoulder pain (Kehr’s sign) occurs from diaphragmatic irritation caused by blood in the peritoneal cavity. Hypotension or shock points to significant hemorrhage, and a positive FAST confirms free intraperitoneal fluid, which in this context is typically blood from splenic injury. The other findings don’t fit as well: right upper quadrant tenderness with Murphy’s sign suggests gallbladder disease rather than spleen injury; lower abdominal tenderness with a positive FAST is less specific to spleen; neck stiffness and photophobia point to CNS processes such as meningitis or subarachnoid hemorrhage.