View source for Abdominal guarding

{{Short description|Tensing of abdominal wall muscles to guard inflamed organs}}
'''Abdominal guarding''' is the tensing of the [[abdominal muscles|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.<ref>{{Cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=7200 |title=Abdominal guarding definition – Medical Dictionary definitions of popular medical terms easily defined on MedTerms<!-- Bot generated title --> |access-date=2007-05-08 |archive-date=2013-03-22 |archive-url=https://web.archive.org/web/20130322001426/http://www.medterms.com/script/main/art.asp?articlekey=7200 |url-status=dead }}</ref> 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.<ref>[http://www.medicineonline.com/articles/a/2/abdominal-guarding/abdominal-rigidity.html Abdominal Guarding - Abdominal Rigidity on Medicine Online Medical Articles] {{webarchive |url=https://web.archive.org/web/20110424023437/http://www.medicineonline.com/articles/a/2/abdominal-guarding/abdominal-rigidity.html |date=April 24, 2011 }}</ref>

==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 (medical disorder)|Intussusception]]
* [[Mesenteric ischemia]]
* [[Nephrolithiasis]]
* [[Ovarian cyst]]
* [[Pancreatitis]]
* [[Pelvic inflammatory disease]]
* [[Perforated ulcer|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]])
<!--=== Physical Examination ===-->

=== 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 cyst]]s
*:* 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
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{{Digestive system and abdomen symptoms and signs}}

{{DEFAULTSORT:Abdominal Guarding}}
[[Category:Symptoms and signs: Digestive system and abdomen]]