Need help understanding a UW question

[cbdoctor]

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34 y/o with abdominal pain after being "hit". VSS, no n/v; + rebound tenderness. AXR, Abdominal U/S, Abdominal CT all negative. Hct 40%, amylase 53. What is next step in management?
A. Observation
B. Angiography
C. Contrast studies of GI
D. DPL
E. Laparotomy

I put A. Observation. Answer is D. DPL. With a neg Abd U/S and CT why is DPL still needed?

Thanks for the help

 

[arthrodisiac]

Abd U/S and CT can miss small bleeds. Rebound tenderness, there probably going for peritoneal irritation. Since his vss, no lap, but dpl first with non penetrating trauma. You can also say, if someone has rebound tenderness, are you going to observe them?

 

[ozzie20]

I'd have to agree with cbdoctor, the question isn't a good one. R/o laparotomy b/c there arent signs of blood loss yet. the OLD way was DPL. the problem with that is that it just tells you yes or no to blood, regardless of amount of blood or whether the bleed will stop. The problem here is this: if the DPL is + for blood, the next logical step was to go to laparotomy. what if you get in there and find only a small bleeder that didn't even need surgery, or a small amount of blood that had already stopped? (btw, this is mostly just what the study video i had said, not just my opinion)

the CT and US are much more accurate in this regard, it can tell you whether there is a bleed or not, and whether or not its significant. The fact that they were both normal would lead me to say this pt needs to be observed.