Abdominal examination by palpation for tenderness and rigidity

http://obesity-medical.blogspot.com/2013/11/abdominal-examination-Abdominal examination by palpation for tenderness and rigidi
   as we mentioned before the methods of abdominal examination by palpation we know talking about the following sign which should be searched carefully during abdominal palpation 1- abdominal tenderness before palpating for tenderness ask the patient to point to the painful area if he is not definite about it ask him to take a deep breath or cough when a sharp increase of pain helps him to locate the tender
area there are two types of tenderness may be elicited 1- local tenderness 2- rebound tenderness 1- local tenderness which there is tenderness on pressure is constant over an inflammatory lesion and it is location is of great diagnostic value as in appendicitis (at mcBurney,s point) cholecystitis (at the tip of the right ninth costal cartilage) and in pyelitis (at the renal angle)2- rebound tenderness an increase of pain following sudden release of pressure over the lesion is known as rebound tenderness this sign is often observed in peritonitis from any cause and it is presence in a case of intestinal obstruction is very suggestive of strangulation of the bowel 2- abdominal rigidity feel gently for muscular rigidity by applying the hand with light pill-rolling movement over different regions of the abdomen rigidity renders the abdominal wall hard and immobile and interferes with deep palpation rigidity should be differentiated from guarding as voluntary spasm of the abdominal muscles on attempting to palpate over a tender or inflamed area during inspection the abdominal wall moves normally with respiration indicating the absence of rigidity but once the hand is applied to the abdomen the patient holds his muscles stiff in anticipation of being hurt unlike rigidity ,guarding disappears during expiration and is usually bilateral true rigidity is a sign of irritation of the parietal peritoneum from any cause such as inflammatory exudate blood or content of hollow viscera it is absent in all colics as there is no cause of peritoneal irritation rigidity usually corresponding with area of maximum tenderness and like tenderness it is site and extend area of great diagnostic value as in appendicitis rigidity is usually elicited over the right iliac fossa but in retroceacal appendix it may present in the loin and in pelvic appendix it is often absent rigidity of the upper part of the right rectus is suggestive of acute cholecystitis or
perforated peptic ulcer in the latter it rapidly extends to produce the characteristic board- like rigidity of the abdomen rigidity of the whole abdomen indicates generalized peritonitis but in late cases with sever toxaemia it is a slight or absent particularly in typhoid perforation and postoperative peritonitis


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