subject: The 3 Critical Components Of The Abdominal Exam [print this page] When it's not the lungs (pneumonia) of the urine (UTI/pyelonephritis,) you have to evaluate the abdomen and CFS. Understanding the abdominal exam is critical.
There are three physical findings in the evaluation of the abdomen, guarding, rebound and rigidity. Now, a little bit about pathophysiology of the abdomen. You have all your intestines, held in place by your peritoneum. When the muscular structors clamp down because of irritation, that is called peritonitis. You must gain experience in the abdominal evaluation but examining a number of patients . If you know a patient has a surgical abdomen, even if it's not your patient, go feel their abdomen.
If a patient voluntarily flexes his stomach, they have guarding. If you want a good example of this, especially if your are a girl, go up to a guy in a bar and grab his biceps. Now, what a guy will typically do is he will flex his biceps voluntarily, kind of saying, Hey, my arm is always strong, Im a strong guy.If a patient has a voluntary flexion of the the right lower quadrant, that is known as guarding. Rigidity is an unresponsive flexing of stomach muscles, where you cannot get him to relax or distract him so you can examine the belly because they are constantly flexed. We call this a rigid abdomen, that usually represents a surgical urgency. If you shake the peritoneum and it hurts, that represents rebound tenderness. Now, from the physical exam perspective, as I am sure you folks know, you push down on one part of the belly, you let go, and that let go vibrates the peritoneum which causes pain at the site of irritation. Another way to do this is to do a heel jar test. This is where I would approach a patient from the bedside, make a closed fist and actually strike the heel of the foot a number of times. The inflammatory response causes pain at the site of inflamed organ. From an historical perspective, this is where you would ask the patient, Did every bump on the car ride over cause you pain?WIth every little stimulation of the abdomen, such as hitting a little bump in the road, that is caused by rebound tenderness.
