## Distinguishing Features of Splenic vs Hepatic Injury ### Anatomical & Clinical Presentation **Key Point:** The location and referred pain pattern are the primary clinical discriminators between splenic and hepatic injuries. | Feature | Splenic Injury | Hepatic Injury | |---------|---|---| | **Location** | Left upper quadrant | Right upper quadrant | | **Tenderness** | Left upper quadrant | Right upper quadrant | | **Referred Pain** | Kehr sign (left shoulder pain) | Right shoulder pain (less common) | | **Mechanism** | Blunt trauma to left flank/ribs 9–11 | Blunt trauma to right flank/ribs 5–10 | ### Kehr Sign Explained **Clinical Pearl:** Kehr sign (left shoulder pain radiating from the left upper quadrant) occurs due to diaphragmatic irritation from splenic bleeding and is a classic finding in splenic injury. This referred pain via the phrenic nerve (C3–C5) is highly specific for splenic pathology. ### Management Differences **High-Yield:** Both splenic and hepatic injuries can be managed conservatively in hemodynamically stable patients with appropriate imaging grade, regardless of organ. The key discriminator is the clinical presentation location and referred pain pattern, not the management approach. **Mnemonic:** **SPLEEN = Left** (Splenic injury = Left upper quadrant + Kehr sign). **LIVER = Right** (Hepatic injury = Right upper quadrant). ### Why Other Options Are Incorrect - **Right upper quadrant tenderness** is a feature of hepatic injury, not splenic injury. - **Delayed rupture** can occur with both organs, though splenic injuries are classically associated with this risk; it is not the primary discriminator. - **Operative requirement** depends on hemodynamic stability and grade for both organs; neither invariably requires surgery. [cite:ATLS 10e Ch 8] 
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