Abdominal guarding is the 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 abdominal wall is pressed. Abdominal guarding is also known as défense musculaire. 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 Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a r ...

diverticulitis Diverticulitis, specifically colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches— diverticula—which can develop in the wall of the large intestine. Symptoms typically include lower abdomin ...

. The tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being disturbed.Abdominal Guarding - Abdominal Rigidity on Medicine Online Medical Articles

Diagnosis

Differential diagnosis

Abdominal aortic aneurysm Abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal. They usually cause no symptoms, except during rupture. Occasionally, abdominal ...

Appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a r ...

* Blunt force trauma to the abdomen *

Bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs ...

Diverticulitis Diverticulitis, specifically colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches— diverticula—which can develop in the wall of the large intestine. Symptoms typically include lower abdomin ...

Dyspepsia Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier ...

Ectopic pregnancy Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these sympt ...

* GERD * Ileus *

Inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine and large intestine, as wel ...

Intussusception Intussusception may refer to: * Intussusception (medical disorder) Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. It typically involves the small bowel and less commonly t ...

Mesenteric ischemia Intestinal ischemia is a medical condition in which injury to the large or small intestine occurs due to not enough blood supply. It can come on suddenly, known as acute intestinal ischemia, or gradually, known as chronic intestinal ischemia. Th ...

* Nephrolithiasis * Ovarian cyst *

Pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. There are two main types: acute pancreatitis, and chronic p ...

Pelvic inflammatory disease Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no ...

* Perforated peptic ulcer disease *

Pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severi ...

* Spontaneous bacterial peritonitis (SBP) *

Urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidne ...

pyelonephritis Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications ma ...

Volvulus A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction. Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool. Onset of symptoms m ...

* Zoster *:* Skin lesions may not be visible until another day or two * Abdominal migraine * Abdominal wall strain/injury * Abscess (e.g. iliopsoas) * Hepatic or splenic contusion/laceration * Incarcerated hernia * Insect toxins (e.g. black widow spider) *

Malingering Malingering is the fabrication, feigning, or exaggeration of physical or psychological symptoms designed to achieve a desired outcome, such as relief from duty or work. Malingering is not a medical diagnosis, but may be recorded as a "focus of c ...

* Pneumoperitoneum secondary to abdominal trauma * Septic miscarriage (See

Miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical ...

)

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 An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus ...

*:*

Echocardiography or ultrasound

* Pelvic, abdominal and/or transvaginal ultrasound diagnoses: *:*

Peritonitis Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or ...

*:*

*:* Ovarian cysts *:* Fluid/blood secondary to trauma *:*

*:*

Other imaging findings

* KUB x-ray imaging (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 Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil Turmoil may refer to: * ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte * ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...

: Lorazepam *:* Zoster: Acyclovir

Treatment

* Specific conditions need direct treatment * Hemodynamic status and life-threatening 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

* 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

*Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3 {{DEFAULTSORT:Abdominal Guarding Symptoms and signs: Digestive system and abdomen