Abdominal guarding: Difference between revisions

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Revision as of 15:05, 5 June 2013

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] ^[3]

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, pneumoperitoneumsecondary 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, pneumoperitoneumsecondary to trauma
Urologic	Nephrolithiasis, pyelonephritis, urinary tract infection
Miscellaneous	No underlying causes

Causes of Abdominal guarding in Alphabetical Order

Diagnosis

Laboratory Findings

Complete blood count (CBC)
Blood urea nitrogen (BUN)/creatinine
Liver function tests (LFTs)
Glucose
Amylase/lipase
Urine culture
Urinalysis
Beta-human chorionic gonadotropin (beta-hCG)
Cervical cultures are recommended to diagnose pelvic inflammatory disease

Electrolyte and Biomarker Studies

Electrolytes

MRI and CT

CT diagnoses:
- Organ contusion
- Organ laceration
- Aneurysm
- Diverticulitis
- Appendicitis

Echocardiography or Ultrasound

Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
- Peritonitis
- Ectopic pregnancy
- Ovarian cysts
- Fluid/blood secondary to trauma
- Appendicitis
- Aneurysm

Other Imaging Findings

KUB x-rays (kidney, ureter, bladder) could reveal nephrolithiasis and bowel gas pattern

Other Diagnostic Studies

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
- Helicobacter pylori" testing may also be used
Trial medications may be beneficial for the diagnosis and treatment of:
- GERD / dyspepsia: Proton pump inhibitors or H2 blockers
- Abdominal wall strain: Nonsteriodal anti-inflammatory drugs (NSAIDs)
- Anxiety: Lorazepam
- Zoster: Acyclovir

Treatment

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

Medical Therapy

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

↑ Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
↑ http://www.medicineonline.com/encyclopedia/A/Abdominal-Guarding/Abdominal-Rigidity
↑ 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

[1] Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms

[2] ttp://www.medicineonline.com/encyclopedia/A/Abdominal-Guarding/Abdominal-Rigidity

[3] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3

[1]

[2]

[3]

@@ Line 27: / Line 27: @@
 *[[Appendicitis]]
 *[[Peritonitis]]
+*[[Diverticulitis]]
 *[[Pyelonephritis]]
 *[[Hepatic]] or [[splenic]] [[contusion]]/[[laceration]]
@@ Line 36: / Line 37: @@
 {|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]]
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  [[Abdominal aortic aneurysm]],  [[aneurysm]], [[mesenteric ischemia]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 64: / Line 65: @@
 |-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|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|pneumoperitoneumsecondary to trauma]],  [[spontaneous bacterial peritonitis|spontaneous bacterial peritonitis (SBP)]],  [[volvulus]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 84: / Line 85: @@
 |-bgcolor="LightSteelBlue"
 | '''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"
 | '''Neurologic'''
-|bgcolor="Beige"| •  [[Abdominal migraine]]
+|bgcolor="Beige"|  [[Abdominal migraine]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 96: / Line 97: @@
 |-bgcolor="LightSteelBlue"
 | '''Obstetric/Gynecologic'''
-|bgcolor="Beige"| •  [[Ectopic pregnancy]] •  [[Ovarian cyst]] •  [[Pelvic inflammatory disease]]
+|bgcolor="Beige"|  [[Ectopic pregnancy]],  [[ovarian cyst]],  [[pelvic inflammatory disease]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| •  [[Ovarian cyst]]
+|bgcolor="Beige"|  [[Ovarian cyst]]
 |-bgcolor="LightSteelBlue"
@@ Line 108: / Line 109: @@
 |-bgcolor="LightSteelBlue"
 | '''Overdose / Toxicity'''
-|bgcolor="Beige"| •  [[Toxin|Insect toxins (e.g. black widow spider)]]
+|bgcolor="Beige"|  [[toxin|Insect toxins (e.g. black widow spider)]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Psychiatric'''
-|bgcolor="Beige"| •  [[Anxiety]] •  [[Malingering]]
+|bgcolor="Beige"|  [[Anxiety]],  [[malingering]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 120: / Line 121: @@
 |-bgcolor="LightSteelBlue"
 | '''Renal / Electrolyte'''
-|bgcolor="Beige"| •  [[Nephrolithiasis]] •  [[Pyelonephritis]] •  [[Urinary tract infection]]
+|bgcolor="Beige"|  [[Nephrolithiasis]], [[pyelonephritis]],  [[urinary tract infection]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 132: / Line 133: @@
 |-bgcolor="LightSteelBlue"
 | '''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|pneumoperitoneumsecondary to trauma]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Urologic'''
-|bgcolor="Beige"| •  [[Nephrolithiasis]] •  [[Pyelonephritis]] •  [[Urinary tract infection]]
+|bgcolor="Beige"|  [[Nephrolithiasis]],  [[pyelonephritis]],  [[urinary tract infection]]
 |-
 |-bgcolor="LightSteelBlue"

v t e Symptoms and signs: circulatory (R00–R03, 785)
Cardiovascular	Template:Navbox subgroup
Myeloid/blood	Template:Navbox subgroup

v t e Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage	Epistaxis Hemoptysis
Abnormalities of breathing	Respiratory sounds Stridor Wheeze Crackles Rhonchi Hamman's sign Apnea Dyspnea Hyperventilation/Hypoventilation Hyperpnea/Tachypnea/Hypopnea/Bradypnea Orthopnea/Platypnea Trepopnea Biot's respiration Cheyne-Stokes respiration Kussmaul breathing Hiccup Mouth breathing/Snoring Breath-holding
Other	Asphyxia Cough Pleurisy Sputum Respiratory arrest Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy Egophony Bronchophony Pleural friction rub Fremitus Silhouette sign
Chest, general	Chest pain Precordial catch syndrome

v t e Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
GI tract	Template:Navbox subgroup
Accessory	Hepatosplenomegaly/Hepatomegaly Jaundice
Abdominopelvic	Ascites
Abdominal – general	Abdominal pain (Acute abdomen, Colic, Baby colic) Splenomegaly Abdominal guarding · Abdominal mass · Rebound tenderness Shifting dullness · Bulging flanks · Puddle sign · Fluid wave test

v t e Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
Ingestion/Weight	decrease: Anorexia • Weight loss/Cachexia/Underweight increase: Polyphagia • Polydipsia • Orexigenia • Weight gain
Growth	Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)