Abdominal Tenderness
February 15th, 2021
Focal Abdominal Tenderness
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
Generalised Abdominal Tenderness
Feel For
- Generalised tenderness over more than one abdominal segment.
Significance
- A feature of peritonism, suggestive of peritonitis.
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
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