Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdominal wall is pressed. Abdominal guarding is also known as 'défense musculaire'.

Guarding is a characteristic finding in the physical examination for an abruptly painful abdomen (an acute abdomen) with inflammation of the inner abdominal (peritoneal) surface due, for example, to appendicitis

Appendicitis

Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...

 or diverticulitis

Diverticulitis

Diverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon...

. The tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being disturbed.

Differential Diagnosis

• Appendicitis
  Appendicitis
  Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
  
  
• Pancreatitis
  Pancreatitis
  Pancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...
  
  
• Diverticulitis
  Diverticulitis
  Diverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon...
  
  
• Abdominal wall strain/injury
• Pelvic inflammatory disease
  Pelvic inflammatory disease
  Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
  
  
• Ectopic pregnancy
  Ectopic pregnancy
  An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
  
  
• Septic miscarriage (See Miscarriage
  Miscarriage
  Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
  
  )
• Bowel obstruction
  Bowel obstruction
  Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency...
  
  
• Ileus
  Ileus
  Ileus is a disruption of the normal propulsive ability of the gastrointestinal tract.Ileus is commonly defined simply as bowel obstruction. However, authoritative sources define it as decreased motor activity of the GI tract due to non-mechanical causes...
  
  
• Pneumonia
  Pneumonia
  Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
  
  
• Dyspepsia
  Dyspepsia
  Dyspepsia , also known as upset stomach or indigestion, refers to a condition of impaired digestion. It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating...
  
  
• Nephrolithiasis
• Perforated Peptic ulcer disease
• Abdominal aortic aneurysm
  Abdominal aortic aneurysm
  Abdominal aortic aneurysm is a localized dilatation of the abdominal aorta exceeding the normal diameter by more than 50 percent, and is the most common form of aortic aneurysm...
  
  
• Anxiety
  Anxiety
  Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
  
  
• Malingering
• Spontaneous bacterial peritonitis
  Spontaneous bacterial peritonitis
  Spontaneous bacterial peritonitis is the development of peritonitis despite the absence of an obvious source for the infection. It occurs almost exclusively in people with portal hypertension , usually as a result of cirrhosis of the liver...
  
   (SBP)
• Mesenteric ischemia
  Mesenteric ischemia
  Mesenteric ischemia is a medical condition in which inflammation and injury of the small intestine result from inadequate blood supply. Causes of the reduced blood flow can include changes in the systemic circulation or local factors such as constriction of blood vessels or a blood clot...
  
  
• GERD
  Gerd
  In Norse mythology, Gerðr is a jötunn, goddess, and the wife of the god Freyr. Gerðr is attested in the Poetic Edda, compiled in the 13th century from earlier traditional sources; the Prose Edda and Heimskringla, written in the 13th century by Snorri Sturluson; and in the poetry of skalds...
  
  
• Ovarian cyst
  Ovarian cyst
  An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange....
  
  
• Hepatic or splenic contusion/laceration
• Pneumoperitoneum secondary to abdominal trauma
  Abdominal trauma
  Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection...
  
  
• Urinary tract infection
  Urinary tract infection
  A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
  
  /pyelonephritis
  Pyelonephritis
  Pyelonephritis is an ascending urinary tract infection that has reached the pyelum or pelvis of the kidney. It is a form of nephritis that is also referred to as pyelitis...
  
  
• Zoster

  • Skin lesions may not be visible until another day or two

• Insect toxins (e.g. black widow spider)
• Abscess (e.g. iliopsoas)
• Incarcerated hernia
• Abdominal migraine
• Intussusception
  Intussusception (medical disorder)
  An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another. This can often result in an obstruction...
  
  
• Volvulus
  Volvulus
  A volvulus is a bowel obstruction with a loop of bowel whose nose has abnormally twisted on itself.-Types:* Volvulus Neonatorum.* Volvulus Small Intestine.* Volvulus Caecum.* Volvulus Sigmoid Colon .* Gastric volvulus....
  
  

Laboratory Findings

• Complete blood count (CBC)
• Blood urea nitrogen (BUN)/creatinine
• Liver function tests (LFTs)
• Glucose
• Amylase/lipase
• Urine culture
• Urinalysis
• Beta-human chorionic gonadotropin (beta-hCG)
• Cervical cultures are recommended to diagnose pelvic inflammatory disease

MRI and CT

• CT diagnoses:

  • Organ contusion
  • Organ laceration
  • Aneurysm
    Aneurysm
    An aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart...
    
    
  • Diverticulitis
    Diverticulitis
    Diverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon...
    
    
  • Appendicitis
    Appendicitis
    Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
    
    

Echocardiography or Ultrasound

• Pelvic, abdominal and/or transvaginal ultrasound diagnoses:

  • Peritonitis
    Peritonitis
    Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
    
    
  • Ectopic pregnancy
    Ectopic pregnancy
    An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
    
    
  • Ovarian cyst
    Ovarian cyst
    An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange....
    
    s
  • Fluid/blood secondary to trauma
  • Appendicitis
    Appendicitis
    Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
    
    
  • Aneurysm
    Aneurysm
    An aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart...
    
    

Other Imaging Findings

• KUB x-rays (kidney, ureter, bladder) could reveal nephrolithiasis and bowel gas pattern

Other Diagnostic Studies

• Symptomatic relief may be provided by paracentesis, which may also diagnose spontaneous bacterial peritonitis (SBP)
• Gastrointestinal endoscopy may be used or patients with suspected peptic ulcer disease

  • Helicobacter pylori" testing may also be used

• Trial medications may be beneficial for the diagnosis and treatment of:

  • GERD/dyspepsia: Proton pump inhibitors or H2 blockers
  • Abdominal wall strain: Nonsteriodal anti-inflammatory drugs (NSAIDs)
  • Anxiety
    Anxiety
    Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
    
    : Lorazepam
  • Zoster: Acyclovir

Treatment

• Specific conditions need direct treatment
• Hemodynamic status and life-theratening disease require immediate attention

  • Volume replacement with a possible blood transfusion, and with normal saline

• For obstruction and persistent vomiting, place nasogastric (NG) tube

Pharmacotherapy

• If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics

Surgery and Device Based Therapy

• Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)