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 or diverticulitis. 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 Appendicitis Blunt force trauma to the abdomen Bowel obstruction Diverticulitis Dyspepsia Ectopic pregnancy GERD Ileus Inflammatory bowel disease Intussusception Mesenteric ischemia Nephrolithiasis Ovarian cyst Pancreatitis Pelvic inflammatory disease Perforated peptic ulcer disease Pneumonia Spontaneous bacterial peritonitis (SBP) Urinary tract infection/pyelonephritis Volvulus 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 Pneumoperitoneum secondary to abdominal trauma Septic miscarriage (See Miscarriage)
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 Diverticulitis Appendicitis
Echocardiography or ultrasound Pelvic, abdominal and/or transvaginal ultrasound diagnoses: Peritonitis Ectopic pregnancy Ovarian cysts Fluid/blood secondary to trauma Appendicitis Aneurysm
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: 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