Rebound tenderness overview

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Overview

Historical Perspective

Pathophysiology

Causes

Epidemiology and Demographics

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Echocardiography or Ultrasound

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Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Rebound tenderness is one of the most important signs of peritonitis when evaluating an acute abdomen. In recent years the value of rebound tenderness has been questioned, since it may not add any diagnostic value beyond the observation that the patient has severe tenderness.

Pathophysiology

Rebound tenderness is thought to be due to stretching of the peritoneum.

Epidemiology and Demographics

Children, the immunocompromised, and the elderly are less likely to show peritoneal signs and may have atypical presentations.

Diagnosis

Physical Examination

Rebound tenderness is a clinical sign that a doctor may detect in physical examination of a patient's abdomen. It refers to pain upon removal of pressure rather than application of pressure to the abdomen. (The latter is referred to simply as abdominal tenderness.) To elicit the sign, gentle pressure is placed on the abdomen and then the hand is lifted suddenly. A sudden increase in abdominal pain occurs when the examiner's hand is lifted. The other physical examination findings to distinguish rebound tenderness are abdominal tenderness and guarding.

Treatment

Medical Therapy

Blood volume should be immediately replaced with saline and/or blood transfusion for those patients that are hemodynamically unstable and bowel rest for diverticulitis or bowel obstruction (possible colon resection).

Surgery

Indications for surgery when elicited would be as a result of life threatening emergencies such as; early sepsis or evidence of hemorrhage, which would require immediate surgical intervention, ruptured aneurysm, ectopic pregnancy, bowel perforation or other pathologies require definite surgical repair.

References

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