Assessing For Peritonism
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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