Rebound tenderness [Blumberg's sign]

A reliable indicator of peritonitis, rebound tenderness is intense, elicited abdominal pain caused by rebound of palpated tissue. The tenderness may be localized, as in an abscess, or generalized, as in perforation of an intra-abdominal organ. Rebound tenderness usually occurs with abdominal pain, tenderness, and rigidity. When a patient has sudden, severe abdominal pain, this symptom is usually elicited to detect peritoneal inflammation.

Emergency interventions If you elicit rebound tenderness in a patient who’s experiencing constant, severe abdominal pain, quickly take his vital signs. Insert a large-bore I.V. catheter, and begin administering I.V. fluids. Also insert an indwelling urinary catheter, and monitor intake and output. Give supplemental oxygen as needed, and continue to monitor the patient for signs of shock, such as hypotension and tachycardia.

History and physical examination

If the patient’s condition permits, ask him to describe the events that led up to the tenderness. Does movement, exertion, or any other activity relieve or aggravate the tenderness? Also, ask about other signs and symptoms, such as nausea and vomiting, fever, or abdominal bloating or distention. Inspect the abdomen for distention, visible peristaltic waves, and scars. Then auscultate for bowel sounds and characterize their motility. Palpate for associated rigidity or guarding and percuss the abdomen noting any tympany. (See Eliciting rebound tenderness.)

Medical causes

Peritonitis

With this life-threatening disorder, rebound tenderness is accompanied by sudden and severe abdominal pain, which may be either diffuse or localized. Because movement worsens the patient’s pain, he’ll usually lie still on his back with his knees flexed. Typically, he’ll display weakness, pallor, excessive sweating, and cold skin. He may also display hypoactive or absent bowel sounds; tachypnea; nausea and vomiting; abdominal distention, rigidity and guarding; positive psoas and obturator signs; and a fever of 103° F (39.4° C) or higher. Inflammation of the diaphragmatic peritoneum may cause shoulder pain and hiccups.

Special considerations

Promote comfort by having the patient flex his knees or assume semi-Fowler’s position. If administering an analgesic, keep in mind that it could mask associated symptoms. You may also administer an antiemetic and an antipyretic. However, because of decreased intestinal motility and the probability that the patient will have surgery, don’t give oral drugs or fluids. Obtain samples of blood, urine, and feces for laboratory testing, and prepare the patient for chest and abdominal X-rays, sonograms, and computed tomography scans. Perform a rectal or pelvic examination. Prepare the patient to receive an antibiotic, have a nasogastric tube inserted, to maintain a nothing-by-mouth status and to receive continuous parenteral fluid or nutrition.

Pediatric pointers

Eliciting rebound tenderness may be difficult in young children. Be alert for such clues as an anguished facial expression or intensified crying. When you elicit this symptom, use assessment techniques that produce minimal tenderness. For example, have the child hop or jump to allow tissue to rebound gently and watch as the child clutches at the furniture in pain.

Geriatric pointers

Rebound tenderness may be diminished or absent in elderly patients.

Pictures

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

Other Book Chapters Related to Abdominal rebound tenderness

Read excerpts from these other book chapters related to Abdominal rebound tenderness:

Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Abdominal rebound tenderness

• Back to symptom: Abdominal rebound tenderness: Introduction (review 3 causes)
• Next Book Extract About Abdominal rebound tenderness: Abdominal Pain (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• All Book Extracts: All Online Book Extracts for Abdominal rebound tenderness

More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

 » Next page: Abdominal Pain (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Abdominal Pain (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• Flank Pain (Field Guide to Bedside Diagnosis)
• Chronic/Recurrent Abdominal Pain (Field Guide to Bedside Diagnosis)
• Abdominal/Pelvic Mass (Field Guide to Bedside Diagnosis)
• Acute Abdominal Pain (Field Guide to Bedside Diagnosis)

Tools & Services:

• Bookmark this page
• Take a survey relating to Abdominal rebound tenderness
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com