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Definition of Abdominal guarding

Contents 1 Overview 2 Differential Diagnosis 3 Physical Examination 4 Laboratory Findings 4.1 Electrolyte and Biomarker Studies 4.2 MRI and CT 4.3 Echocardiography or Ultrasound 4.4 Other Imaging Findings 4.4.1 Angiography 4.5 Other Diagnostic Studies 5 Treatment 5.1 Pharmacotherapy 5.1.1 Acute Pharmacotherapies 5.1.1.1 References 5.1.2 Chronic Pharmacotherapies 5.1.2.1 References 5.2 Surgery and Device Based Therapy 5.3 References 5.4 Acknowledgements 5.5 Suggested Reading and Key General References 5.6 Suggested Links and Web Resources 5.7 For Patients 5.8 Notes

[edit] 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]

[edit] Differential Diagnosis

• Appendicitis
• Pancreatitis
• Diverticulitis
• Abdominal wall strain/injury
• Pelvic inflammatory disease
• Ectopic pregnancy
• Bowel obstruction
• Ileus
• Pneumonia
• Dyspepsia
• Nephrolithiasis
• Peptic ulcer disease
• Abdominal aortic aneurysm
• Anxiety
• Malingering
• Spontaneous bacterial peritonitis (SBP)
• Mesenteric ischemia
• GERD
• Ovarian cyst
• Hepatic or splenic contusion/laceration
• Pneumoperitoneum secondary to trauma
• Urinary tract infection/pyelonephritis
• Zoster

  • Skin lesions may not be visible until another day or two

• Insect toxins (e.g. black widow spider)
• Abscess (e.g. iliopsoas)
• Incarcerated hernia
• Abdominal migraine
• Intussusception
• Volvulus

[edit] Physical Examination

[edit] 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

[edit] Electrolyte and Biomarker Studies

• Electrolytes

[edit] MRI and CT

• CT diagnoses:

  • Organ contusion
  • Organ laceration
  • Aneurysm
  • Diverticulitis
  • Appendicitis

[edit] Echocardiography or Ultrasound

• Pelvic, abdominal and/or transvaginal ultrasound diagnoses:

  • Peritonitis
  • Ectopic pregnancy
  • Ovarian cysts
  • Fluid/blood secondary to trauma
  • Appendicitis
  • Aneurysm

[edit] Other Imaging Findings

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

[edit] Angiography

[edit] 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

[edit] 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

[edit] Pharmacotherapy

[edit] Acute Pharmacotherapies

• If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics

[edit] References

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[edit] Chronic Pharmacotherapies

[edit] References

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[edit] Surgery and Device Based Therapy

• Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)

[edit] References

^[3]

1. ^ Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
2. ^ http://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

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[edit] Acknowledgements

The content on this page was first contributed by Heather Mangan, Caitlin Harrigan and Template:CMG

List of contributors:

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[edit] Suggested Reading and Key General References

[edit] Suggested Links and Web Resources

[edit] For Patients

[edit] Notes

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