Abdominal Tenderness
Ask the patient to indicate where on the abdomen is painful. Superficially palpate the nine segments of the abdomen to elicit tenderness. If none is present, palpate more deeply.
Interpretation
- Right hypochondrium - liver, gallbladder, stomach, hepatic flexure of colon, lungGallstones, peptic ulcer
- Epigastrium - liver, gallbladder, stomach, transverse colon, pancreas, heartPancreatitis, peptic ulcer, reflux
- Left hypochondrium - spleen, pancreas, stomach, splenic flexure of colon, lungPeptic ulcer, pancreatitis
- Right lumbar - ascending colon, kidneyKidney stone, pyelonephritis
- Umbilicus - small bowel, aortaPancreatitis, early appendicitis, peptic ulcer, IBD
- Left lumbar - descending colon, kidneyKidney stone, diverticulitis, IBD
- Right iliac fossa - appendix, terminal ileum, caecum, ovary, fallopian tube, ureterAppendicitis, caecal diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia
- Hypogastrium - uterus, bladder, sigmoid colonCystitis, appendicitis, diverticulitis, IBD, uterine pathology
- Left iliac fossa - sigmoid colon, ovary, fallopian tube, ureterSigmoid diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia
Signs of Peritonism
Peritonism refers to inflammation of the peritoneum, which suggests acute abdominal pathology that should be rapidly diagnosed and treated.
Signs of Peritonism
- Generalised abdominal tenderness
- Percussion tenderness - gently percuss the abdominal wall over an area of tenderness. Note whether percussion tenderness is localised or generalised.
- Rebound tenderness - apply pressure to the patient's abdomen over a tender area for 5-10 seconds. Remove the pressure suddenly, and ask the patient if it hurts more when you press or remove your hand.
Causes of Peritonism
- Infection post perforation - appendix, diverticulitis, IBD, perforated ulcer, surgical anastomosis
- Spontaneous bacterial peritonitis (SBP)
- Blood - endometriosis, ruptured ovarian cyst, trauma
- Bile - post-surgical
- Urine - pelvic trauma
- Pancreatic fluid - pancreatitis
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