Abdominal guarding

Abdominal guarding

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]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

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.

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.

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
• Spontaneous bacterial peritonitis (SBP)
• Urinary tract infection/pyelonephritis
• Volvulus
• Zoster

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

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)