Abdominal guarding

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

Synonyms and keywords: Rebound, rigidity, rigid abdomen.

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]

• Abdominal aortic aneurysm
• Appendicitis
• Bowel obstruction
• Hepatic or splenic contusion/laceration
• Ileus
• Incarcerated hernia
• Mesenteric ischemia
• Peritonitis
• Pyelonephritis
• Volvulus

• Appendicitis
• Peritonitis
• Diverticulitis
• Pyelonephritis
• Hepatic or splenic contusion/laceration
• Bowel obstruction
• Ileus

• Abdominal aortic aneurysm
• Abdominal migraine
• Abdominal wall strain/injury
• Abscess (e.g. iliopsoas)
• Aneurysm
• Anxiety
• Appendicitis
• Bowel obstruction
• Diverticulitis
• Ectopic pregnancy
• Fluid/blood secondary to trauma
• Hepatic or splenic contusion/laceration
• Ileus
• Incarcerated hernia
• Insect toxins (e.g. black widow spider)
• Intussusception
• Malingering
• Mesenteric ischemia
• Nephrolithiasis
• Organ contusion
• Organ laceration
• Ovarian cyst
• Pancreatitis
• Pelvic inflammatory disease
• Peptic ulcer disease
• Peritonitis
• Pneumoperitoneum secondary to trauma
• Pyelonephritis
• Spontaneous bacterial peritonitis (SBP)
• Urinary tract infection
• Volvulus

• 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

• Electrolytes

• CT diagnoses:

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

• Pelvic, abdominal and/or transvaginal ultrasound diagnoses:

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

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

• 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

• 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

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

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

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