Which abdominal exam findings are characteristic of peritonitis and abdominal sepsis?

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

On abdominal examination, almost all patients demonstrate tenderness to palpation. In most patients—even those with generalized peritonitis and severe diffuse abdominal pain—the point of maximal tenderness or referred rebound tenderness roughly overlies the pathologic process (ie, the site of maximal peritoneal irritation).

Most patients demonstrate increased abdominal wall rigidity. The increase in abdominal wall muscular tone may be voluntary, in response to or in anticipation of the abdominal examination, or involuntary because of the peritoneal irritation. Patients with severe peritonitis often avoid all motion and keep their hips flexed to relieve the abdominal wall tension. The abdomen is often distended, with hypoactive-to-absent bowel sounds. This finding reflects a generalized ileus and may not be present if the infection is well localized. Occasionally, the abdominal examination reveals an inflammatory mass.

Signs of hepatic failure (eg, jaundice, angiomata) may be noted.


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