Medical symptom checker - Peritoneal signs / abdominal rigidity - General overview

mesenteric artery ischemia
mesenteric artery ischemia
peritonitis
peritonitis
black widow spider
black widow spider

Medical symptom checker - Peritoneal signs / abdominal rigidity - General overview

Introduction

What is abdominal rigidity ? Abdominal rigidity refers to inflexibility of the abdomen that present as an abnormal muscle tone. Abdominal rigidity is divided into voluntary or involuntary abdominal rigidity. Voluntary abdominal rigidity is reflecting the patient’s nervousness and fear when the clinician tries to palpate the abdomen. The involuntary abdominal rigidity is associated with irritation of the peritoneum and it is life threatening. Involuntary abdominal rigidity may also be associated with gastrointestinal, pulmonary, vascular disorders and the side effect of the insect toxin. The involuntary rigidity is accompanied with abdominal pain, tenderness, rebound tenderness, guarding ( peritoneal signs) and nausea, fever and vomiting.

Assessment of patient with abdominal rigidity

The assessment abdominal rigidity requires a proper history and examination skills to highlight the other signs and symptoms. ( To justify the present of life threatening peritoneal signs ). The sites of abdominal rigidity ( localized or generalized) are worth knowing. It is also important to discover any associated condition such as abdominal pain. If abdominal pain is present, full history regarding abdominal pain is taken from the patient. Remember to ask the patient about any action or condition that will worsen the abdominal rigidity such as walking, vomiting or coughing. The patient also needs to be asked questions regarding the character of the abdominal rigidity ( either it remains constant or radiated to other sites of the body )

The abdomen is inspected for any evidence of visible bowel distention or visible peristalsis wave which are common in a very thin patient. Palpate slightly to determine the severity of abdominal rigidity . Clinicians are advised not to perform deep palpation that may exacerbate the abdominal pain. Check for any signs of dehydration such as dry mucous membrane.

Differential diagnosis of abdominal rigidity

The most common causes of abdominal rigidity may include peritonitis, mesenteric artery ischemia , abdominal aortic aneurysm and insect toxin.

Peritonitis

Peritonitis may be divided into localized and generalized peritonitis. Inflamed appendix ( appendicitis ) may present as localized peritonitis ( presents with abdominal rigidity, rebound tenderness and guarding ) in the right lower quadrants. Perforated peptic ulcer is associated with generalized peritonitis .( The rigidity is generalized/ widespread or known as ‘board like’) .Generalized abdominal rigidity is accompanied with generalized abdominal pain. The patient may also suffer from nausea, vomiting, guarding, rebound tenderness, hypo active, absence of bowel sound, hyperalgesia and abdominal distention as well as abdominal tenderness. Any signs of shocks are also noticeable such as hypotension, tachycardia, tachypnea, fever and chills.

Mesenteric artery ischemia

Mesenteric artery ischemia is a life threatening condition that presents as 2 -3 days history of diarrhea and low/mild abdominal pain which later develop onto severe abdominal pain and rigidity. The abdominal rigidity is felt in the peri umbilical region . The patient typically present with signs of shocks such as tachycardia, tachypnea, hypotension as well as diarrhea, nausea and vomiting. Mesenteric artery ischemia is suspected in patient > 50 years old, with a history of cardiovascular infarction, hypotension, heart failure and arrhythmias.

Dissecting abdominal aortic aneurysm

A dissecting abdominal aortic aneurysm is a life threatening condition . Typically it is presented with constant upper abdominal pain in mild to moderate cases. In the worst case scenario, the patient prefers to lean forward or sitting up when he suffer the pain while lying down . The patient typically presents with the following signs and symptoms :

-Pulsatile mass is felt on the umbilicus. Pulsation will disappear if the aneurysm is ruptured.

Bruit is identifiable on the umbilical aortic region.

-Patient may also present with absence of femoral pulses and pedal pulses.

-Lower blood pressure when measured in the leg compared to the arm.

-Guarding and tenderness in the abdominal region.

-Mottled skin appearance.

Rupture of the aneurysm may lead to excessive blood loss which leads to shock. The patient will suffer from pale, cold, clammy appearance, hypotension, tachycardia and tachypnea.

Insect bites

Insect stings or bites such as black spider bites may release a toxin which causes abdominal rigidity. Besides that patient may also complain of cramping and abdominal pain. Other signs may include low grade fever, nausea, vomiting, burning sensation in the hands and feet as well as tremor. In severe cases, patients may present with high blood pressure, (hypertension), hyper salivation hyperactive reflex and paresis. Children will mostly keep the legs flexed, appear restless and expiratory grunt.

Special consideration

The patient should lie supine with knees slightly flexed to relax the abdominal muscle, head flat on the tables and arm of the sides.

The patient should be monitored for the signs of shock.

Avoid early prescription analgesic as it may mask the symptoms. Analgesic is withheld until the definite diagnosis is made.

Withhold food and fluid and consider the prescription of IV antibiotics in case the patient requires emergency surgery. The diagnostic test requires may include, blood, stool and urine studies and abdominal and plain chest x ray .Rectal exam or pelvic exam and gastroscopy/ colonoscopy as well as peritoneal lavages are also performed.

Children may present with abdominal rigidity as a result of cystic fibrosis, intussuception , duodenal obstruction, hypertrophic pyloric stenosis, gastric perforation, appendicitis and coeliac disease

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