Tachycardia, hypotension, and acute abdominal tenderness after abdominal trauma indicate what kind of injury?

• A. Aneurysm rupture
• B. Hollow visceral organ injury
• C. Retroperitoneal hematoma
• D. Solid visceral organ injury (spleen or liver)

Answer: (D)

When the abdomen becomes tender after blunt trauma and the patient shows a fast heartbeat with low blood pressure, this pattern points to active intraperitoneal bleeding from a solid visceral organ. Solid organs like the spleen and liver are highly vascular, so when they’re injured they bleed quickly into the abdominal cavity. That rapid blood loss drops the circulating blood volume, triggering tachycardia and hypotension, and the bleeding irritates the peritoneum, causing acute tenderness.

Hollow viscus injuries can cause abdominal pain too, but they don’t usually present with immediate, severe shock from bleeding right away. They may cause pain and later peritonitis once leakage or infection develops. Retroperitoneal hematomas can occur, but they often produce back or flank pain and may not present with diffuse acute abdominal tenderness or rapid shock in the same way. A preexisting aneurysm rupture isn’t caused by the acute trauma pattern and isn’t the most likely explanation in this setting.

So the combination of shock-like signs with acute abdominal tenderness after blunt trauma most strongly suggests injury to a solid visceral organ with intraperitoneal hemorrhage.