STUDY - Technical - New Dacian's Medicine
Abdominal
rigidity (Classical / Allopathic Medicine)
Detected by
palpation, abdominal rigidity refers to abdominal muscle
tension or inflexibility of the abdomen. Rigidity may be
voluntary or involuntary. Voluntary rigidity reflects the
patient's fear of or nervousness about palpation; involuntary
rigidity reflects potentially life-threatening peritoneal
irritation or inflammation.
Involuntary
rigidity usually results from a GI disorder but may result
from a pulmonary or vascular disorder or from the effects of
insect toxins. It's typically accompanied by fever, nausea,
vomiting, abdominal tenderness, distention, and pain. (See
Recognizing voluntary rigidity.)
ALERT:
If the patient has abdominal rigidity:
- quickly take his vital signs
- prepare him for laboratory tests and X-rays
- prepare him for emergency surgery, if necessary.
If the patient's condition permits, perform a focused assessment.
If the patient has abdominal rigidity:
- quickly take his vital signs
- prepare him for laboratory tests and X-rays
- prepare him for emergency surgery, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient when signs and symptoms of abdominal rigidity began.
Ask the patient if abdominal rigidity is associated with abdominal pain. If so, did the pain begin at the same time?
Ask the patient if the pain is always present. Also, ask the patient if the site of the pain has changed or remained constant?
Ask the patient about aggravating or alleviating factors, such as position changes, coughing, vomiting, elimination, and walking.
Recognizing voluntary rigidity: Distinguishing voluntary rigidity from involuntary rigidity is essential for accurate assessment.
Voluntary rigidity is: eased by relaxation techniques, such as positioning the patient comfortably and talking to him in a calm, soothing manner; more rigid on inspiration (expiration causes muscle relaxation); painless when the patient sits up using his abdominal muscles alone; usually symmetrical.
Involuntary rigidity is: equally rigid on inspiration and expiration; painful when the patient sits up using his abdominal muscles; unaffected by relaxation techniques; usually asymmetrical.
Ask the patient when signs and symptoms of abdominal rigidity began.
Ask the patient if abdominal rigidity is associated with abdominal pain. If so, did the pain begin at the same time?
Ask the patient if the pain is always present. Also, ask the patient if the site of the pain has changed or remained constant?
Ask the patient about aggravating or alleviating factors, such as position changes, coughing, vomiting, elimination, and walking.
Recognizing voluntary rigidity: Distinguishing voluntary rigidity from involuntary rigidity is essential for accurate assessment.
Voluntary rigidity is: eased by relaxation techniques, such as positioning the patient comfortably and talking to him in a calm, soothing manner; more rigid on inspiration (expiration causes muscle relaxation); painless when the patient sits up using his abdominal muscles alone; usually symmetrical.
Involuntary rigidity is: equally rigid on inspiration and expiration; painful when the patient sits up using his abdominal muscles; unaffected by relaxation techniques; usually asymmetrical.
PHYSICAL
ASSESSMENT:
Inspect the abdomen for peristaltic waves, which may be visible in very thin patients. Also, check for a visibly distended bowel loop.
Auscultate bowel sounds, and characterize their motility.
Perform light palpation to locate the rigidity and determine its severity. Avoid deep palpation, which may exacerbate abdominal pain.
Check for poor skin turgor and dry mucous membranes, which indicate dehydration.
Inspect the abdomen for peristaltic waves, which may be visible in very thin patients. Also, check for a visibly distended bowel loop.
Auscultate bowel sounds, and characterize their motility.
Perform light palpation to locate the rigidity and determine its severity. Avoid deep palpation, which may exacerbate abdominal pain.
Check for poor skin turgor and dry mucous membranes, which indicate dehydration.
SPECIAL
CONSIDERATIONS:
Withhold analgesics from the patient until a diagnosis is determined because they may mask symptoms. Withhold food and fluids until it's decided that surgery is unnecessary.
Withhold analgesics from the patient until a diagnosis is determined because they may mask symptoms. Withhold food and fluids until it's decided that surgery is unnecessary.
PEDIATRIC
POINTERS:
Voluntary rigidity may be difficult to distinguish from involuntary rigidity if associated pain makes the child restless, tense, or apprehensive. However, in a child with suspected involuntary rigidity, your priority is early detection of dehydration and shock, which can rapidly become life-threatening.
Abdominal rigidity in a child can stem from gastric perforation, hypertrophic pyloric stenosis, duodenal obstruction, meconium ileus, intussusception, cystic fibrosis, celiac disease, or appendicitis.
Voluntary rigidity may be difficult to distinguish from involuntary rigidity if associated pain makes the child restless, tense, or apprehensive. However, in a child with suspected involuntary rigidity, your priority is early detection of dehydration and shock, which can rapidly become life-threatening.
Abdominal rigidity in a child can stem from gastric perforation, hypertrophic pyloric stenosis, duodenal obstruction, meconium ileus, intussusception, cystic fibrosis, celiac disease, or appendicitis.
AGING ISSUES:
Advanced age and impaired cognition decrease pain perception and intensity. Weakening of abdominal muscles may decrease muscle spasms and rigidity.
Advanced age and impaired cognition decrease pain perception and intensity. Weakening of abdominal muscles may decrease muscle spasms and rigidity.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include a pelvic and rectal examination; blood, urine, and stool tests; X-rays; peritoneal lavage; gastroscopy; and colonoscopy. If surgery is required, perform preoperative teaching.
Instruct the patient on what to expect from diagnostic testing, which may include a pelvic and rectal examination; blood, urine, and stool tests; X-rays; peritoneal lavage; gastroscopy; and colonoscopy. If surgery is required, perform preoperative teaching.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)