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48 yr old mail. Injured his xyphoid process at work by a…

48 yr old mail. Injured...
48 yr old mail. Injured his xyphoid process at work by a blow to it approximately six weeks ago. Xyphoid still painful and his liver is now painful to touch. Doctor did not take an xray of sternum only stomach.
An ultrasound showed his liver looks fatty.
Doctor has ordered No other tests or made Any suggestions.
What tests and procedures should he be insisting on?
He is healthy otherwise, very little alcohol, and could lose maybe ten pounds.
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Answered in 6 minutes by:
4/20/2018
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 10,237
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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Hi,
Welcome to JA and thanks for this question. I'm sorry to hear about the patient in question. Actually, if the pain is still present and the xiphoid process is painful to touch that could mean that there is persistent inflammation at the site of injury. Now, this could be arthritis at the site as the xiphoid process is attached to the sternum or it could be inflammation of the tendons of the surrounding muscles which attach near the xiphoid process. Regardless of the cause, the next best step here is to actually get an MRI of the location. An x-ray alone would not be enough as it would only show the bones in the region and the soft tissues, which could be responsible for the pain, would not be seen. This is why an MRI should be done which would be able to diagnose the exact cause of the persistent pain.

Secondly, the presence of pain in the liver region could be indicative of an underlying injury to the liver, ideally, the liver should be have been looked at with an ultrasound of the liver or even a CT scan of the region. Another possibility is that his pain in the liver region is unrelated to the blow and is because of another underlying disorder such as gallbladder disease. Inflammation of the gallbladder can cause this sort of pain and another ultrasound should be able to diagnose the problem. The treatment would be with Iv fluids and IV antibiotics.

However, given the history of trauma, I would like to rule out trauma as a cause first of all and I would suggest that this patient get an MRI of the chest or even a CT scan of the chest and abdomen in order to determine if there is any underlying damage. In the meantime use of OTC anti-inflammatory medications like ibuprofen at a dose of 600 mg thrice daily may be helpful but the tests are certainly required here.

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Customer reply replied 3 months ago
Thank you very much for your detailed answer. Are there blood tests that should also be ordered??

I would recommend that liver function tests along with amylase or lipase should also be done to look at the liver status as well as pancreas as well.

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Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 10,237
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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Customer reply replied 3 months ago
Thank you very much

you are welcome.

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