Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]
Detected by palpation, abdominal rigidity refers to abnormal muscle tension or inflexibility of the abdomen. Rigidity may be voluntary or involuntary. Voluntary rigidity reflects the patient’s fear or nervousness upon palpation; involuntary rigidity reflects potentially life-threatening peritoneal irritation or inflammation. (See Recognizing voluntary rigidity.)
Involuntary rigidity most commonly results from GI disorders, but may also result from pulmonary and vascular disorders and from the effects of insect toxins. Usually, it’s accompanied by fever, nausea, vomiting, and abdominal tenderness, distention, and pain.
Emergency interventions
After palpating abdominal rigidity, quickly take the patient’s vital signs. Even though the patient may not appear gravely ill or have markedly abnormal vital signs, abdominal rigidity calls for emergency interventions.
Prepare to administer oxygen and to insert an I.V. line for fluid and blood replacement. The patient may require drugs to support blood pressure. Also prepare him for catheterization, and monitor intake and output.
A nasogastric tube may have to be inserted to relieve abdominal distention. Because emergency surgery may be necessary, the patient should be prepared for laboratory tests and X-rays.
History and physical examination
If the patient’s condition allows further assessment, take a brief history. Find out when the abdominal rigidity began. Is it associated with abdominal pain? If so, did the pain begin at the same time? Determine whether the abdominal rigidity is localized or generalized. Is it always present? Has its site changed or remained constant? Next, ask about aggravating or alleviating factors, such as position changes, coughing, vomiting, elimination, and walking.
Explore other signs and symptoms. Inspect the abdomen for peristaltic waves, which may be visible in very thin patients. Also, check for a visibly distended bowel loop. Next, auscultate bowel sounds. Perform light palpation to locate the rigidity and determine its severity. Avoid deep palpation, which may exacerbate abdominal pain. Finally, check for poor skin turgor and dry mucous membranes, which indicate dehydration.
Medical causes
❑ Abdominal aortic aneurysm (dissecting). Mild to moderate abdominal rigidity occurs with abdominal aortic aneurysm, a life-threatening disorder. Typically, it’s accompanied by constant upper abdominal pain that may radiate to the lower back. The pain may worsen when the patient lies down and may be relieved when he leans forward or sits up. Before rupture, the aneurysm may produce a pulsating mass in the epigastrium, accompanied by a systolic bruit over the aorta. However, the mass stops pulsating after rupture. Associated signs and symptoms include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, and mild to moderate tenderness with guarding. Significant blood loss causes signs of shock, such as tachycardia, tachypnea, and cool, clammy skin.
❑ Insect toxins. Insect stings and bites, especially black widow spider bites, release toxins that can produce generalized, cramping abdominal pain, usually accompanied by rigidity. These toxins may also cause a low-grade fever, nausea, vomiting, tremors, and burning sensations in the hands and feet. Some patients develop increased salivation, hypertension, paresis, and hyperactive reflexes. Children commonly are restless, have an expiratory grunt, and keep their legs flexed.
❑ Mesenteric artery ischemia. A life-threatening disorder, mesenteric artery ischemia is characterized by 2 to 3 days of persistent, low-grade abdominal pain and diarrhea leading to sudden, severe abdominal pain and rigidity. Rigidity occurs in the central or periumbilical region and is accompanied by severe abdominal tenderness, fever, and signs of shock, such as tachycardia and hypotension. Other findings may include vomiting, anorexia, and diarrhea or constipation. Always suspect this disorder in patients older than age 50 who have a history of heart failure, arrhythmia, cardiovascular infarct, or hypotension.
❑ Peritonitis. Depending on the cause of peritonitis, abdominal rigidity may be localized or generalized. For example, if an inflamed appendix causes local peritonitis, rigidity may be localized in the right lower quadrant. If a perforated ulcer causes widespread peritonitis, rigidity may be generalized and, in severe cases, boardlike.
Peritonitis also causes sudden and severe abdominal pain that can be localized or generalized. In addition, it can produce abdominal tenderness and distention, rebound tenderness, guarding, hyperalgesia, hypoactive or absent bowel sounds, nausea, and vomiting. Usually, the patient also displays fever, chills, tachycardia, tachypnea, and hypotension.
Special considerations
Continue to monitor the patient closely for signs of shock. Position him as comfortably as possible. The patient should lie in a supine position, with his head flat on the table, arms at his sides, and knees slightly flexed to relax the abdominal muscles. Because analgesics may mask symptoms, withhold them until a tentative diagnosis has been made. Because emergency surgery may be required, withhold food and fluids and administer an I.V. antibiotic. Prepare the patient for diagnostic tests, which may include blood, urine, and stool studies; chest and abdominal X-rays; a computed tomography scan; magnetic resonance imaging; peritoneal lavage; and gastroscopy or colonoscopy. A pelvic or rectal examination may also be done.
Pediatric pointers
Voluntary rigidity may be difficult to distinguish from involuntary rigidity if associated pain makes the child restless, tense, or apprehensive. However, in any child with suspected involuntary rigidity, your priority is early detection of dehydration and shock, which can rapidly become life-threatening.
Abdominal rigidity in the child can stem from gastric perforation, hypertrophic pyloric stenosis, duodenal obstruction, meconium ileus, intussusception, cystic fibrosis, celiac disease, and appendicitis.
Geriatric pointers
Advanced age and impaired cognition decrease pain perception and intensity. Weakening of abdominal muscles may decrease muscle spasms and rigidity.
Pictures
![Abdominal rigidity [Abdominal muscle spasm, involuntary guarding] - 4387.1.jpg](/bookimages/5/4387.1.jpg)
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Myopathy
Read excerpts from these other book chapters related to Myopathy:
Medical Books Excerpts
- Muscle spasms
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Myopathy
» Next page: Muscle spasticity [Muscle hypertonicity] (Handbook of Signs & Symptoms (Third Edition))
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