Gastro Exam
 
 

Assessing For Peritonism

 
 
 
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On this page:Percussion TendernessRebound TendernessAbdominal Rigidity
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Overview

  • Peritonism refers to inflammation of the peritoneum, which suggests acute abdominal pathology that should be rapidly diagnosed and treated.

    • Causes of Peritonitis

    • 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

Percussion Tenderness

  • Percussion tenderness provides an incredibly superficial stimulus to the abdomen, and if this is sufficient to cause pain then peritonism should be suspected.

    • How to Elicit

    • Gently percuss the abdominal wall over an area of tenderness. Note whether percussion tenderness is localised or generalised.

Rebound Tenderness

  • Rebound tenderness, also known as the Blumberg sign, refers to tenderness that is worse on removal of the palpating hand than it is on pressing.
  • This clinical sign suggests peritonism, or localised inflammation of the peritoneum.

    • How to Elicit

    • 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.

Abdominal Rigidity

  • Firmness of the abdominal wall muscles may be due to guarding or rigidity. It is important to determine whether this is voluntary, due to the patient's apprehension, or involuntary - a sign of peritonism.

    • Interpretation

    • Guarding - refers to a voluntary muscle contraction, to protect from pain.
    • Rigidity - refers to an involuntary muscle spasm due to underlying inflammation.

    • Feel For

    • Tense abdominal muscles, generally isolated over one segment.

    • Causes of Abdominal Rigidity

    • 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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