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| {{Rebound tenderness}} | | {{Rebound tenderness}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{Ochuko}} |
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| ==Pathophysiology== | | ==[[Rebound tenderness overview|Overview]]== |
| Rebound tenderness is thought to be due to stretching of the peritoneum.
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| ==Physical Examination technique== | | ==[[Rebound tenderness historical perspective|Historical Perspective]]== |
| 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]].
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| ==Epidemiology and Demographcis== | | ==[[Rebound tenderness pathophysiology|Pathophysiology]]== |
| Immunocompromised, children and the elderly are less likely to show peritoneal signs and may have atypical presentations.
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| ==Causes== | | ==[[Rebound tenderness causes|Causes]]== |
| 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>
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| * [[Appendicitis]]
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| * [[Bacterial peritonitis]]
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| * [[Biliary colic]] or [[renal colic]]
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| * [[Bowel obstruction]]
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| * [[Cholecystitis]]
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| * [[Colitis]]
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| * [[Diverticulitis]]
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| * [[Gastritis]]
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| * [[Gastroenteritis]]
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| * Gynecologic etiologies
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| *:* Ovarian cyst torsion or rupture
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| *:* Ruptured [[ectopic pregnancy]]
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| *:* Tubo-ovarian abscess
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| *:* [[Pelvic Inflammatory Disease]]
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| * Intra-abdominal or pelvic abscess
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| * [[Intussusception]]
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| * [[Mesenteric ischemia]]
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| * Nonabdominal causes of pain. For example:
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| *:* [[Atypical angina]]
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| *:* [[Myocardial Infarction]]
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| *:* Pelvic pathology
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| *:* [[Pericarditis]]
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| *:* [[Pneumonia]]
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| *:* [[Pulmonary embolus]]
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| * [[Pancreatitis]]
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| * [[Perforated duodenal ulcer]]
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| * Perforated viscus
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| * [[Ruptured abdominal aortic aneurysm]]
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| * [[Sickle cell crisis]]
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| == Diagnosis == | | ==[[Rebound tenderness epidemiology and demographics|Epidemiology and Demographics]]== |
| === History and Symptoms ===
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| * Location of pain, nature, intensity, onset, duration
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| * Guarding
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| * Past episodes
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| * Distention
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| * Bowel sounds
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| * Blood on rectal exam
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| * Presence of mass
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| * Cervical or adnexal tenderness
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| * Factors that alleviate pain
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| * Factors that aggravate pain
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| * Crampy, colicky pain occuring in waves (distention)
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| * Pain that is constant and localized in nature (inflammation)
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| * Shock
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| * Hypotension
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| == Laboratory Findings == | | ==Diagnosis== |
| * [[Complete blood count]] (CBC)
| | [[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]] |
| * [[BUN]] ([[blood urea nitrogen]])/[[creatinine]]
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| * [[LFT]]s ([[liver function tests]])
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| * [[Pregnancy test]]
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| * [[Urinalysis]]
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| * [[Amylase]]/[[lipase]]
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| === Electrolyte and Biomarker Studies === | | ==Treatment== |
| * [[Electrolytes]]
| | [[Rebound tenderness medical therapy|Medical Therapy]] | [[Rebound tenderness surgery|Surgery]] |
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| === X-Ray === | | ==Case Studies== |
| * Obstruction, perforation or other pathologies revealed by abdominal X-ray.
| | [[Rebound tenderness case study one|Case #1]] |
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| === Echocardiography or Ultrasound ===
| | {{Symptoms and signs}} |
| * [[Ultrasound]] can test for the following:
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| *:* [[Abdominal aortic aneurysm]]
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| *:* [[Ectopic pregnancy]]
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| *:* Biliary disorders
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| *:* [[Diverticulitis]]
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| === Other Diagnostic Studies ===
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| * Peritoneal lavage recommended for suspected trauma, peritonitis, or bowel perforation
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| * Persistent [[vomiting]] and obstruction require a nasogastric tub
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| == Treatment ==
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| * Surgery
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| * Immediately replace volume with saline and/or blood transfusion for those patients are are hemodynamically unstable
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| * Bowel rest for diverticulitis or bowel obstruction (possible colon resection)
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| == Pharmacotherapy ==
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| === Acute Pharmacotherapies ===
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| * If intra-abdominal infection or perforated viscus is suspected, administer proper course of antibiotics
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| === Indications for Surgery ===
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| * Life threatening emergencies such as; early sepsis or evidence of hemorrhage, require immediate surgical intervention
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| * Ruptured aneurysm, ectopic pregnancy, bowel perforation or ther pathologies require definite surgical repair.
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| == References ==
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| {{Reflist|2}}
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| {{Symptoms and signs}} } | |
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| [[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]] |