What is Abdominal Guarding?
Abdominal guarding is involuntary tensing and response of the muscles of the abdominal wall to protect the inflamed or injured organs present within the abdomen from feeling the pressure or pain. Abdominal guarding is felt when someone palpates or presses the abdominal wall. Abdominal guarding is a characteristic finding observed during physical examination for acute painful abdomen with peritonitis. The cause could be diverticulitis or appendicitis. The injured muscles of the abdominal wall tense or stiffen involuntarily by going into a spasm to protect the underlying injured organs and tissues from being disturbed. Abdominal guarding is an involuntary response by the abdominal muscles to prevent pain that can be felt from examination of the abdomen.
Abdominal guarding is different from intentionally flexing the muscles of the abdomen and the tenseness or rigidity felt in people with severe gas. Abdominal guarding is completely involuntary in nature and is an indication that the body is trying to protect itself from further pain. Abdominal guarding can also be a sign of a serious and even fatal medical condition. If you have abdominal guarding, then it is important to seek immediate medical attention.
What Causes Abdominal Guarding?
Abdominal guarding and abdominal pain go hand in hand. Patients having abdominal pain will have abdominal guarding. Abdominal pain can be due to a variety of causes, such as problems with abdominal organs, which include liver, gallbladder, pancreas, small and large intestines, stomach, aorta, ureters and kidneys. Appendicitis is the commonest cause of abdominal guarding.
Any problems with the pelvic organs, such as bladder, uterus, lower ureters, rectum, ovaries and fallopian tubes (in women) and prostate gland (in men) can also produce abdominal guarding. Very rarely, lower lung diseases may also cause abdominal pain and guarding.
The site of the abdominal pain depends on the organ, which is causing the problem. Our abdomen is divided into four quadrants. If the patient is suffering from stomach ulcers, then pain is felt in the left upper quadrant. If gallstones are present, then pain is felt in the right upper quadrant of the abdomen. The pain of the appendicitis is initially felt in the right lower quadrant and then moves towards the umbilicus. Whatever, the location of the abdominal pain, it leads to the response of abdominal guarding in the patient.
As mentioned before, there are different causes of abdominal pain and abdominal guarding. The cause in the adults could be abdominal abscess or cholecystitis. Other causes of abdominal guarding from abdominal pain include bowel obstruction, cancer, perforation in the stomach, intestines, or gall bladder, pancreatitis, gastroenteritis, colic, pyloric stenosis, viral infection, abdominal injury and peritonitis. Dysmenorrhea can also cause abdominal guarding in female adolescents. Other causes for abdominal guarding in women include pelvic inflammatory disease, peritonitis, ovarian cysts or ectopic pregnancy.
Symptoms Associated with Abdominal Guarding
Abdominal guarding is almost always a sign of medical emergency. Other serious symptoms, which can occur with abdominal guarding and indicate a life threatening condition include:
- Hematemesis (vomiting blood).
- Melena (black, tarry stools).
- Rectal bleeding.
- Inability to eat or drink.
- Severe vomiting.
- Distended abdomen or increased abdominal girth.
- Severe hypotension.
Other symptoms associated with abdominal guarding include:
- Abdominal tenderness.
- Loss of appetite.
- Diarrhea or constipation.
Diagnosis of Abdominal Guarding
If the patient has involuntary abdominal guarding, then it is important to consult a doctor immediately to exclude any serious problem. The cause of abdominal guarding could also be something minor, such as a stomach virus. So, it is important to diagnose the cause of abdominal guarding before any appropriate treatment can be started. Patient should not take medications to alleviate the pain in the abdomen without consulting a doctor first, as taking unnecessary medications will change the pattern of the pain and make it difficult to diagnose the actual underlying condition for muscle guarding.
The doctor will ask questions, such as the time when the symptoms started, the nature of the pain; whether it is sharp, dull, intermittent, duration of the pain and the activity which triggered the abdominal pain, what makes the pain better and worse. Other symptoms besides abdominal guarding should be conveyed to the doctor. After the patient's medical history is discussed, the doctor then performs a physical exam and order lab tests such as:
- CBC (complete blood count).
- BUN (blood urea nitrogen).
- Serum creatinine (indication of kidney functioning).
- Serum electrolytes (potassium, sodium, chloride, bicarbonate).
- Liver function tests.
- Ultrasound scanning of the abdomen and pelvis.
- Stool tests.
- X-rays of the abdomen.
- Abdominal ultrasound.
- CT scan of the abdomen.
How is Abdominal Guarding Treated?
Treatment for abdominal guarding depends on the underlying cause. For minor conditions, which cause abdominal guarding, such as colic, treatment will be simple, such as observation of the patient and prescribing antibiotics etc. For serious cases, such as cancer, treatment will be different and more aggressive.
Treatment also includes intravenous fluids to the patient for preventing dehydration, intravenous antibiotics, nasogastric feeding tube and surgery if needed.
Complications of Abdominal Guarding
If the cause of abdominal guarding is not treated, then it can prove to be fatal. If the cause is abdominal infection, then the bacteria can enter the blood stream (septicemia) and there can be a severe drop in the blood pressure resulting in the patient being in shock. If the patient has extreme loss of blood, then it can also prove to be very fatal. Prolonged vomiting and diarrhea can lead to electrolyte imbalance and dehydration along with abnormal heart rhythm, kidney failure and shock.