Abdominal guarding: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(13 intermediate revisions by 4 users not shown)
Line 1: Line 1:
{{Infobox_Disease |
__NOTOC__
  Name          = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB    = |
  ICD10          = |
  ICD9          = |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = |
}}
{{SI}}
{{SI}}
{{CMG}}
{{CMG}}


{{Editor Help}}
{{SK}} Rebound, rigidity, rigid abdomen.
 
'''''Key words and synonyms:''''' 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.
<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>


==Medical Emergencies Associated with Abdominal Guarding==
==Medical Emergencies Associated with Abdominal Guarding==
Line 39: Line 22:
*[[Volvulus]]
*[[Volvulus]]


==Complete Differential Diagnosis of Causes of Abdominal guarding (alphabetical):==
==Causes==
*[[Abdominal aortic aneurysm]]
===Common Causes===
*[[Abdominal migraine]]
*[[Abdominal wall]] [[strain]]/[[injury]]
*[[Abscess]] (e.g. [[iliopsoas]])
*[[Aneurysm]]
*[[Anxiety]]
*[[Appendicitis]]
*[[Appendicitis]]
*[[Bowel obstruction]]
*[[Peritonitis]]
*[[Diverticulitis]]
*[[Diverticulitis]]
*[[Dyspepsia]]
*[[Pyelonephritis]]
*[[Ectopic pregnancy]]
*Fluid/[[blood]] secondary to [[trauma]]
*[[GERD]]
*[[Hepatic]] or [[splenic]] [[contusion]]/[[laceration]]
*[[Hepatic]] or [[splenic]] [[contusion]]/[[laceration]]
*[[Bowel obstruction]]
*[[Ileus]]
*[[Ileus]]
*[[Incarcerated hernia]]
*Insect [[toxin]]s (e.g. black widow spider)
*[[Intussusception (medical disorder)|Intussusception]]
*[[Malingering]]
*[[Mesenteric ischemia]]
*[[Nephrolithiasis]]
*[[contusion|Organ contusion]]
*[[laceration|Organ laceration]]
*[[Ovarian cyst]]
*[[Pancreatitis]]
*[[Pelvic inflammatory disease]]
*[[Peptic ulcer disease]]
*[[Peritonitis]]
*[[Pneumonia]]
*[[Pneumoperitoneum]] secondary to [[trauma]]
*[[Pyelonephritis]]
*[[Spontaneous bacterial peritonitis|Spontaneous bacterial peritonitis (SBP)]]
*[[Urinary tract infection]]
*[[Volvulus]]


==Complete Differential Diagnosis of the Causes of Abdominal guarding (by organ system)==
===Causes of Abdominal guarding by organ system===


{|style="width:80%; height:100px" border="1"
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|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]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  [[Abdominal aortic aneurysm]], [[aneurysm]], [[mesenteric ischemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 107: Line 64:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"|•  [[Abscess|Abscess (e.g. iliopsoas)]] • [[Appendicitis]] • [[Bowel obstruction]] • [[Diverticulitis]] • [[GERD]]•  [[Contusion|Hepatic or splenic contusion/laceration]] • [[Ileus]] • [[Intussusception (medical disorder)|Intussusception]] • [[Incarcerated hernia]] • [[Mesenteric ischemia]]• [[Pancreatitis]] • [[Peptic ulcer disease]] • [[Peritonitis]] • [[Pneumoperitoneum|Pneumoperitoneumsecondary to trauma]] • [[Spontaneous bacterial peritonitis|Spontaneous bacterial peritonitis (SBP)]] • [[Volvulus]]
|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"
|-bgcolor="LightSteelBlue"
Line 127: Line 84:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| • [[Abdominal wall|Abdominal wall strain/injury]]• [[Contusion|Organ contusion]]
|bgcolor="Beige"|  [[abdominal wall|Abdominal wall strain/injury]], [[contusion|organ contusion]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| • [[Abdominal migraine]]
|bgcolor="Beige"|  [[Abdominal migraine]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 139: Line 96:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| • [[Ectopic pregnancy]] • [[Ovarian cyst]] • [[Pelvic inflammatory disease]]
|bgcolor="Beige"|  [[Ectopic pregnancy]], [[ovarian cyst]], [[pelvic inflammatory disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| • [[Ovarian cyst]]
|bgcolor="Beige"|  [[Ovarian cyst]]


|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 151: Line 108:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| • [[Toxin|Insect toxins (e.g. black widow spider)]]
|bgcolor="Beige"|  [[toxin|Insect toxins (e.g. black widow spider)]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| • [[Anxiety]] • [[Malingering]]
|bgcolor="Beige"|  [[Anxiety]], [[malingering]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| •  [[Pneumonia]]
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| • [[Nephrolithiasis]] •  [[Pyelonephritis]] • [[Urinary tract infection]]
|bgcolor="Beige"|  [[Nephrolithiasis]], [[pyelonephritis]], [[urinary tract infection]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 175: Line 132:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| • [[Trauma|Fluid/blood secondary to trauma]] • [[Contusion|Hepatic or splenic contusion/laceration]] • [[Contusion|Organ contusion]]• [[Laceration|Organ laceration]] • [[Pneumoperitoneum|Pneumoperitoneumsecondary to 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"
|-bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| • [[Nephrolithiasis]] • [[Pyelonephritis]] • [[Urinary tract infection]]
|bgcolor="Beige"|  [[Nephrolithiasis]], [[pyelonephritis]], [[urinary tract infection]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 187: Line 144:
|}
|}


== Laboratory Findings ==  
===Causes of Abdominal guarding in Alphabetical Order===
*[[Abdominal aortic aneurysm]]
*[[Abdominal migraine]]
*[[Abdominal wall]] [[strain]]/[[injury]]
*[[Abscess]] (e.g. [[iliopsoas]])
*[[Aneurysm]]
*[[Anxiety]]
*[[Appendicitis]]
*[[Bowel obstruction]]
*[[Diverticulitis]]
*[[Ectopic pregnancy]]
*Fluid/[[blood]] secondary to [[trauma]]
*[[Hepatic]] or [[splenic]] [[contusion]]/[[laceration]]
*[[Ileus]]
*[[Incarcerated hernia]]
*Insect [[toxin]]s (e.g. black widow spider)
*[[Intussusception (medical disorder)|Intussusception]]
*[[Malingering]]
*[[Mesenteric ischemia]]
*[[Nephrolithiasis]]
*[[contusion|Organ contusion]]
*[[laceration|Organ laceration]]
*[[Ovarian cyst]]
*[[Pancreatitis]]
*[[Pelvic inflammatory disease]]
*[[Peptic ulcer disease]]
*[[Peritonitis]]
*[[Pneumoperitoneum]] secondary to [[trauma]]
*[[Pyelonephritis]]
*[[Spontaneous bacterial peritonitis|Spontaneous bacterial peritonitis (SBP)]]
*[[Urinary tract infection]]
*[[Volvulus]]
 
==Diagnosis==
===Laboratory Findings===  
* [[Complete blood count]] ([[CBC]])
* [[Complete blood count]] ([[CBC]])
* [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]]
* [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]]
Line 198: Line 189:
* 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
Line 209: Line 200:
*:* [[Appendicitis]]
*:* [[Appendicitis]]


=== Echocardiography or Ultrasound ===  
===Echocardiography or Ultrasound===  
* Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
* Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
*:* [[Peritonitis]]
*:* [[Peritonitis]]
Line 218: Line 209:
*:* [[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 231: 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}}
 
 
{{symptoms and signs}}
{{symptoms and signs}}
{{SIB}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Symptoms]]
[[Category:Medical signs]]
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
[[Category:Physical examination]]
[[Category:Physical examination]]
[[Category:Ddx]]
[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
 
{{WH}}
{{WS}}

Latest revision as of 15:08, 29 May 2015

WikiDoc Resources for Abdominal guarding

Articles

Most recent articles on Abdominal guarding

Most cited articles on Abdominal guarding

Review articles on Abdominal guarding

Articles on Abdominal guarding in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Abdominal guarding

Images of Abdominal guarding

Photos of Abdominal guarding

Podcasts & MP3s on Abdominal guarding

Videos on Abdominal guarding

Evidence Based Medicine

Cochrane Collaboration on Abdominal guarding

Bandolier on Abdominal guarding

TRIP on Abdominal guarding

Clinical Trials

Ongoing Trials on Abdominal guarding at Clinical Trials.gov

Trial results on Abdominal guarding

Clinical Trials on Abdominal guarding at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Abdominal guarding

NICE Guidance on Abdominal guarding

NHS PRODIGY Guidance

FDA on Abdominal guarding

CDC on Abdominal guarding

Books

Books on Abdominal guarding

News

Abdominal guarding in the news

Be alerted to news on Abdominal guarding

News trends on Abdominal guarding

Commentary

Blogs on Abdominal guarding

Definitions

Definitions of Abdominal guarding

Patient Resources / Community

Patient resources on Abdominal guarding

Discussion groups on Abdominal guarding

Patient Handouts on Abdominal guarding

Directions to Hospitals Treating Abdominal guarding

Risk calculators and risk factors for Abdominal guarding

Healthcare Provider Resources

Symptoms of Abdominal guarding

Causes & Risk Factors for Abdominal guarding

Diagnostic studies for Abdominal guarding

Treatment of Abdominal guarding

Continuing Medical Education (CME)

CME Programs on Abdominal guarding

International

Abdominal guarding en Espanol

Abdominal guarding en Francais

Business

Abdominal guarding in the Marketplace

Patents on Abdominal guarding

Experimental / Informatics

List of terms related to Abdominal guarding

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


Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Abdominal_guarding&oldid=1103154"