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