Peritonitis physical examination
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Peritonitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Overview
Physical Examination
Appearance of the patient
- Patients with peritonitis are usually ill-appearing, initially they appear alert, restless and irritable.They may later become apathetic and delirious.
- They are often noticed lying quietly supine,on the bed with the knees flexed and with frequent limited intercostal respirations because any motion intensifies the abdominal pain.
Vital signs
- Hyperthermia (temperatures as high as 42° C) and hypothermia (temperatures as low as 35° C) may be present depending on the stage of the disease.
- Hypothermia is a grave sign,seen late in the course of the disease in patients with on-going intra-abdominal sepsis or septic shock.
- Tachycardia with weak, thready peripheral pulses represents decreased effective circulating blood volume,indicating a stage of shock later in the disease.
- Tachypnea
- The blood pressure is maintained within normal limits early in the disease process and as peritonitis progresses, the blood pressure decreases to shock levels.
Abdomen
- Marked abdominal tenderness to palpation is present, usually maximum over the organ in which the process originated.
- Direct and referred rebound tenderness is almost always present and signifies the irritation of the parietal peritoneum.
- Muscular rigidity of the abdominal wall produced by voluntary guarding and reflex muscular spasm is almost always present.
- Hyper-resonance on percussion if present,indicates the gaseous dissention of the intestine.
- Pneumoperitoneum, which results from gas/air in the peritoneal cavity, results usually from a ruptured hollow viscus produces liver dullness to percussion
- Bowel sounds vary along the course of peritonitis, are initially hypoactive, and may disappear later.Absence of bowel sounds may be the only manifestation of peritonitis in some patients, and a high index of suspicion is necessary