Abdominal guarding

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Abdominal guarding

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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] [3]

Complete Differential Diagnosis of Causes of Abdominal guarding (alphabetical):

Complete Differential Diagnosis of the Causes of Abdominal guarding

Cardiovascular Abdominal aortic aneurysmAneurysmMesenteric 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)AppendicitisBowel obstructionDiverticulitisGERDHepatic or splenic contusion/lacerationIleusIntussusceptionIncarcerated herniaMesenteric ischemiaPancreatitisPeptic ulcer diseasePeritonitisPneumoperitoneumsecondary to traumaSpontaneous 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/injuryOrgan contusion
Neurologic Abdominal migraine
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Ectopic pregnancyOvarian cystPelvic inflammatory disease
Oncologic Ovarian cyst
Opthalmologic No underlying causes
Overdose / Toxicity Insect toxins (e.g. black widow spider)
Psychiatric AnxietyMalingering
Pulmonary Pneumonia
Renal / Electrolyte NephrolithiasisPyelonephritisUrinary tract infection
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Fluid/blood secondary to traumaHepatic or splenic contusion/lacerationOrgan contusionOrgan lacerationPneumoperitoneumsecondary to trauma
Urologic NephrolithiasisPyelonephritisUrinary tract infection
Miscellaneous No underlying causes

Laboratory Findings

Electrolyte and Biomarker Studies

MRI and CT

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

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

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

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