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{{SK}} Rebound, rigidity, rigid abdomen.


== Overview ==
== Overview ==
Abdominal guarding: Tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdomen wall is pressed. <ref>[http://www.medterms.com/script/main/art.asp?articlekey=7200 Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms<!-- Bot generated title -->]</ref>


'''Abdominal guarding''': Tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdomen wall is pressed. <ref>[http://www.medterms.com/script/main/art.asp?articlekey=7200 Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms<!-- Bot generated title -->]</ref>
Guarding is a characteristic finding in the physical examination for an abruptly painful abdomen (an acute abdomen) with [[inflammation]] of the inner abdominal (peritoneal) surface due, for example, to [[appendicitis]] or [[diverticulitis]]. The tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being touched. <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3</ref>


Guarding is a characteristic finding in the physical examination for an abruptly painful abdomen (an acute abdomen) with [[inflammation]] of the inner abdominal (peritoneal) surface due, for example, to [[appendicitis]] or [[diverticulitis]]. The tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being touched.
==Medical Emergencies Associated with Abdominal Guarding==
<ref>http://www.medicineonline.com/encyclopedia/A/Abdominal-Guarding/Abdominal-Rigidity</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3</ref>
*[[Abdominal aortic aneurysm]]
*[[Appendicitis]]
*[[Bowel obstruction]]
*[[Hepatic]] or [[splenic]] [[contusion]]/[[laceration]]
*[[Ileus]]
*[[Incarcerated hernia]]
*[[Mesenteric ischemia]]
*[[Peritonitis]]
*[[Pyelonephritis]]
*[[Volvulus]]
 
==Causes==
===Common Causes===
*[[Appendicitis]]
*[[Peritonitis]]
*[[Diverticulitis]]
*[[Pyelonephritis]]
*[[Hepatic]] or [[splenic]] [[contusion]]/[[laceration]]
*[[Bowel obstruction]]
*[[Ileus]]
 
===Causes of Abdominal guarding by organ system===
 
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  [[Abdominal aortic aneurysm]],  [[aneurysm]], [[mesenteric ischemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Abscess|Abscess (e.g. iliopsoas)]],  [[appendicitis]],  [[bowel obstruction]],  [[diverticulitis]],  [[contusion|hepatic or splenic contusion/laceration]],  [[ileus]],  [[intussusception (medical disorder)|intussusception]],  [[incarcerated hernia]],  [[mesenteric ischemia]],  [[pancreatitis]],  [[peptic ulcer disease]], [[peritonitis]], [[pneumoperitoneum|pneumoperitoneum secondary to trauma]],  [[spontaneous bacterial peritonitis|spontaneous bacterial peritonitis (SBP)]],  [[volvulus]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|  [[abdominal wall|Abdominal wall strain/injury]],  [[contusion|organ contusion]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|  [[Abdominal migraine]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|  [[Ectopic pregnancy]], [[ovarian cyst]], [[pelvic inflammatory disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|  [[Ovarian cyst]]


==Complete Differential Diagnosis of Causes of Abdominal guarding (alphabetical):==
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|  [[toxin|Insect toxins (e.g. black widow spider)]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|  [[Anxiety]],  [[malingering]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|  [[Nephrolithiasis]], [[pyelonephritis]],  [[urinary tract infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|  [[trauma|Fluid/blood secondary to trauma]],  [[contusion|hepatic or splenic contusion/laceration]],  [[contusion|organ contusion]],  [[laceration|organ laceration]],  [[pneumoperitoneum|pneumoperitoneum secondary to trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"|  [[Nephrolithiasis]],  [[pyelonephritis]],  [[urinary tract infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}
 
===Causes of Abdominal guarding in Alphabetical Order===
*[[Abdominal aortic aneurysm]]
*[[Abdominal aortic aneurysm]]
*[[Abdominal migraine]]
*[[Abdominal migraine]]
*[[Abdominal wall strain/injury]]
*[[Abdominal wall]] [[strain]]/[[injury]]
*[[Abscess (e.g. iliopsoas)]]
*[[Abscess]] (e.g. [[iliopsoas]])
*[[Aneurysm]]
*[[Aneurysm]]
*[[Anxiety]]
*[[Anxiety]]
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*[[Bowel obstruction]]
*[[Bowel obstruction]]
*[[Diverticulitis]]
*[[Diverticulitis]]
*[[Dyspepsia]]
*[[Ectopic pregnancy]]
*[[Ectopic pregnancy]]
*[[Fluid/blood secondary to trauma]]
*Fluid/[[blood]] secondary to [[trauma]]
*[[GERD]]
*[[Hepatic]] or [[splenic]] [[contusion]]/[[laceration]]
*[[Hepatic or splenic contusion/laceration]]
*[[Ileus]]
*[[Ileus]]
*[[Incarcerated hernia]]
*[[Incarcerated hernia]]
*[[Insect toxins (e.g. black widow spider)]]
*Insect [[toxin]]s (e.g. black widow spider)
*[[Intussusception]]
*[[Intussusception (medical disorder)|Intussusception]]
*[[Malingering]]
*[[Malingering]]
*[[Mesenteric ischemia]]
*[[Mesenteric ischemia]]
*[[Nephrolithiasis]]
*[[Nephrolithiasis]]
*[[Organ contusion]]
*[[contusion|Organ contusion]]
*[[Organ laceration]]
*[[laceration|Organ laceration]]
*[[Ovarian cyst]]
*[[Ovarian cyst]]
*[[Pancreatitis]]
*[[Pancreatitis]]
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*[[Peptic ulcer disease]]
*[[Peptic ulcer disease]]
*[[Peritonitis]]
*[[Peritonitis]]
*[[Pneumonia]]
*[[Pneumoperitoneum]] secondary to [[trauma]]
*[[Pneumoperitoneum secondary to trauma]]
*[[Pyelonephritis]]
*[[Spontaneous bacterial peritonitis (SBP)]]
*[[Spontaneous bacterial peritonitis|Spontaneous bacterial peritonitis (SBP)]]
*[[Urinary tract infection/pyelonephritis]]
*[[Urinary tract infection]]
*[[Volvulus]]
*[[Volvulus]]
*[[Zoster]]


== Laboratory Findings ==  
==Diagnosis==
===Laboratory Findings===  
* [[Complete blood count]] ([[CBC]])
* [[Complete blood count]] ([[CBC]])
* [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]]
* [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]]
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* Cervical cultures are recommended to diagnose [[pelvic inflammatory disease]]
* Cervical cultures are recommended to diagnose [[pelvic inflammatory disease]]


=== Electrolyte and Biomarker Studies ===  
===Electrolyte and Biomarker Studies===  
* [[Electrolytes]]
* [[Electrolytes]]


=== MRI and CT ===
===MRI and CT===
* CT diagnoses:
* CT diagnoses:
*:* Organ contusion
*:* Organ contusion
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*:* [[Appendicitis]]
*:* [[Appendicitis]]


=== Echocardiography or Ultrasound ===  
===Echocardiography or Ultrasound===  
* Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
* Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
*:* [[Peritonitis]]
*:* [[Peritonitis]]
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*:* [[Aneurysm]]
*:* [[Aneurysm]]


=== Other Imaging Findings ===
===Other Imaging Findings===
* KUB x-rays ([[kidney]], [[ureter]], [[bladder]]) could reveal [[nephrolithiasis]] and bowel gas pattern
* KUB x-rays ([[kidney]], [[ureter]], [[bladder]]) could reveal [[nephrolithiasis]] and bowel gas pattern


=== Other Diagnostic Studies ===
===Other Diagnostic Studies===
* Symptomatic relief may be provided by [[paracentesis]], which may also diagnose [[spontaneous bacterial peritonitis]] (SBP)
* Symptomatic relief may be provided by [[paracentesis]], which may also diagnose [[spontaneous bacterial peritonitis]] (SBP)
* Gastrointestinal [[endoscopy]] may be used or patients with suspected [[peptic ulcer disease]]
* Gastrointestinal [[endoscopy]] may be used or patients with suspected [[peptic ulcer disease]]
Line 105: Line 222:
*:* [[Zoster]]: [[Acyclovir]]
*:* [[Zoster]]: [[Acyclovir]]


== Treatment ==
==Treatment==
===Medical Therapy===
* Specific conditions need direct treatment
* Specific conditions need direct treatment
* Hemodynamic status and life-theratening disease require immediate attention
* Hemodynamic status and life-theratening disease require immediate attention
*:* Volume replacement with a possible blood transfusion, and with normal saline
*:* Volume replacement with a possible blood transfusion, and with normal saline
* For obstruction and persistent vomiting, place nasogastric (NG) tube
* For obstruction and persistent vomiting, place nasogastric (NG) tube
== Pharmacotherapy ==


=== Acute Pharmacotherapies ===  
===Pharmacotherapy===
====Acute Pharmacotherapies====  
* If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics
* If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics


== Surgery and Device Based Therapy ==  
===Surgery and Device Based Therapy===  
* Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)
* Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)


== References ==
==References==
<references/>
{{Reflist|2}}
 
 
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Latest revision as of 15:08, 29 May 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Rebound, rigidity, rigid abdomen.

Overview

Abdominal guarding: Tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdomen wall is pressed. [1]

Guarding is a characteristic finding in the physical examination for an abruptly painful abdomen (an acute abdomen) with inflammation of the inner abdominal (peritoneal) surface due, for example, to appendicitis or diverticulitis. The tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being touched. [2]

Medical Emergencies Associated with Abdominal Guarding

Causes

Common Causes

Causes of Abdominal guarding by organ system

Cardiovascular Abdominal aortic aneurysm, aneurysm, mesenteric ischemia
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Abscess (e.g. iliopsoas), appendicitis, bowel obstruction, diverticulitis, hepatic or splenic contusion/laceration, ileus, intussusception, incarcerated hernia, mesenteric ischemia, pancreatitis, peptic ulcer disease, peritonitis, pneumoperitoneum secondary to trauma, spontaneous bacterial peritonitis (SBP), volvulus
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho Abdominal wall strain/injury, organ contusion
Neurologic Abdominal migraine
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Ectopic pregnancy, ovarian cyst, pelvic inflammatory disease
Oncologic Ovarian cyst
Opthalmologic No underlying causes
Overdose / Toxicity Insect toxins (e.g. black widow spider)
Psychiatric Anxiety, malingering
Pulmonary No underlying causes
Renal / Electrolyte Nephrolithiasis, pyelonephritis, urinary tract infection
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Fluid/blood secondary to trauma, hepatic or splenic contusion/laceration, organ contusion, organ laceration, pneumoperitoneum secondary to trauma
Urologic Nephrolithiasis, pyelonephritis, urinary tract infection
Miscellaneous No underlying causes

Causes of Abdominal guarding in Alphabetical Order

Diagnosis

Laboratory Findings

Electrolyte and Biomarker Studies

MRI and CT

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

  • Specific conditions need direct treatment
  • Hemodynamic status and life-theratening disease require immediate attention
    • Volume replacement with a possible blood transfusion, and with normal saline
  • For obstruction and persistent vomiting, place nasogastric (NG) tube

Pharmacotherapy

Acute Pharmacotherapies

  • If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics

Surgery and Device Based Therapy

  • Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)

References

  1. ↑ Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3


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