Abdominal guarding

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List of terms related to Abdominal guarding

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]

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

Causes of Abdominal guarding in Alphabetical Order

Diagnosis

Laboratory Findings

Electrolyte and Biomarker Studies

MRI and CT

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

  • 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

  1. Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3


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