|
|
| (22 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Rebound tenderness}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{Ochuko}} |
|
| |
|
| ==Overview== | | ==[[Rebound tenderness overview|Overview]]== |
| '''Rebound tenderness''' is one of the most important signs of peritonitis when evaluating an acute abdomen. In recent years the value of rebound tenderness has been questioned, since it may not add any diagnostic value beyond the observation that the patient has severe tenderness.
| |
|
| |
|
| ==Pathophysiology== | | ==[[Rebound tenderness historical perspective|Historical Perspective]]== |
| Rebound tenderness is thought to be due to stretching of the peritoneum.
| |
|
| |
|
| ==Physical Examination technique== | | ==[[Rebound tenderness pathophysiology|Pathophysiology]]== |
| '''Rebound tenderness''' is a clinical sign that a doctor may detect in physical examination of a patient's [[abdomen]]. It refers to pain upon ''removal'' of pressure rather than ''application'' of pressure to the abdomen. (The latter is referred to simply as ''[[abdominal tenderness]]''.) To elicit the sign, gentle pressure is placed on the abdomen and then the hand is lifted suddenly. A sudden increase in abdominal pain occurs when the examiner's hand is lifted. The other physical examination findings to distinguish rebound tenderness from are [[abdominal tenderness]] and [[guarding]].
| |
|
| |
|
| ==Epidemiology and Demographcis== | | ==[[Rebound tenderness causes|Causes]]== |
| Immunocompromised, children and the elderly are less likely to show peritoneal signs and may have atypical presentations.
| |
|
| |
|
| ==Causes== | | ==[[Rebound tenderness epidemiology and demographics|Epidemiology and Demographics]]== |
| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| |
|
| |
|
| * [[Appendicitis]]
| | ==Diagnosis== |
| * [[Bacterial peritonitis]]
| | [[Rebound tenderness history and symptoms|History and Symptoms]] | [[Rebound tenderness physical examination|Physical Examination]] | [[Rebound tenderness laboratory findings|Laboratory Findings]] | [[Rebound tenderness echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Rebound tenderness other imaging findings|Other Imaging Findings]] | [[Rebound tenderness other diagnostic studies|Other Diagnostic Studies]] |
| * [[Biliary colic]] or [[renal colic]]
| |
| * [[Bowel obstruction]]
| |
| * [[Cholecystitis]]
| |
| * [[Colitis]]
| |
| * [[Diverticulitis]]
| |
| * [[Gastritis]]
| |
| * [[Gastroenteritis]]
| |
| * Gynecologic etiologies
| |
| *:* Ovarian cyst torsion or rupture
| |
| *:* Ruptured [[ectopic pregnancy]]
| |
| *:* Tubo-ovarian abscess
| |
| *:* [[Pelvic Inflammatory Disease]]
| |
| * Intra-abdominal or pelvic abscess
| |
| * [[Intussusception]]
| |
| * [[Mesenteric ischemia]]
| |
| * Nonabdominal causes of pain. For example:
| |
| *:* [[Atypical angina]]
| |
| *:* [[Myocardial Infarction]]
| |
| *:* Pelvic pathology
| |
| *:* [[Pericarditis]]
| |
| *:* [[Pneumonia]]
| |
| *:* [[Pulmonary embolus]]
| |
| * [[Pancreatitis]]
| |
| * [[Perforated duodenal ulcer]]
| |
| * Perforated viscus
| |
| * [[Ruptured abdominal aortic aneurysm]]
| |
| * [[Sickle cell crisis]]
| |
|
| |
|
| == Diagnosis == | | ==Treatment== |
| === History and Symptoms ===
| | [[Rebound tenderness medical therapy|Medical Therapy]] | [[Rebound tenderness surgery|Surgery]] |
| * Location of pain, nature, intensity, onset, duration
| |
| * Guarding
| |
| * Past episodes
| |
| * Distention
| |
| * Bowel sounds
| |
| * Blood on rectal exam
| |
| * Presence of mass
| |
| * Cervical or adnexal tenderness
| |
| * Factors that alleviate pain
| |
| * Factors that aggravate pain
| |
| * Crampy, colicky pain occuring in waves (distention)
| |
| * Pain that is constant and localized in nature (inflammation)
| |
| * Shock
| |
| * Hypotension
| |
|
| |
|
| == Laboratory Findings == | | ==Case Studies== |
| * [[Complete blood count]] (CBC)
| | [[Rebound tenderness case study one|Case #1]] |
| * [[BUN]] ([[blood urea nitrogen]])/[[creatinine]]
| |
| * [[LFT]]s ([[liver function tests]])
| |
| * [[Pregnancy test]]
| |
| * [[Urinalysis]]
| |
| * [[Amylase]]/[[lipase]]
| |
|
| |
|
| === Electrolyte and Biomarker Studies ===
| | {{Symptoms and signs}} |
| * [[Electrolytes]]
| |
| | |
| === X-Ray ===
| |
| * Obstruction, perforation or other pathologies revealed by abdominal X-ray.
| |
| | |
| === Echocardiography or Ultrasound ===
| |
| * [[Ultrasound]] can test for the following:
| |
| *:* [[Abdominal aortic aneurysm]]
| |
| *:* [[Ectopic pregnancy]]
| |
| *:* Biliary disorders
| |
| *:* [[Diverticulitis]]
| |
| | |
| === Other Diagnostic Studies ===
| |
| * Peritoneal lavage recommended for suspected trauma, peritonitis, or bowel perforation
| |
| * Persistent [[vomiting]] and obstruction require a nasogastric tub
| |
| | |
| == Treatment ==
| |
| * Surgery
| |
| * Immediately replace volume with saline and/or blood transfusion for those patients are are hemodynamically unstable
| |
| * Bowel rest for diverticulitis or bowel obstruction (possible colon resection)
| |
| == Pharmacotherapy ==
| |
| | |
| === Acute Pharmacotherapies ===
| |
| * If intra-abdominal infection or perforated viscus is suspected, administer proper course of antibiotics
| |
| | |
| === Indications for Surgery ===
| |
| * Life threatening emergencies such as; early sepsis or evidence of hemorrhage, require immediate surgical intervention
| |
| * Ruptured aneurysm, ectopic pregnancy, bowel perforation or ther pathologies require definite surgical repair.
| |
| | |
| == References ==
| |
| {{Reflist}}
| |
| | |
| {{Symptoms and signs}} } | |
|
| |
|
| [[Category:Physical examination]] | | [[Category:Physical examination]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| | [[Category:Medical signs]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Surgery]] | | [[Category:Surgery]] |