Assessing For Peritonism
October 29th, 2020
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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