腹部硬直

WordNet

the muscles of the abdomen (同)abdominal_muscle, ab
of or relating to or near the abdomen; "abdominal muscles"
the physical property of being stiff and resisting bending (同)rigidness

PrepTutorEJDIC

(比較変化なし)腹の,腹部の
三いこと,硬直 / 厳格;厳密,厳正

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/18 10:06:03」(JST)

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Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdominal wall is pressed.^[1] Abdominal guarding is also known as 'défense musculaire'.

Guarding is a characteristic finding in the physical examination for an abruptly painful abdomen (an acute abdomen) with inflammation of the inner abdominal (peritoneal) surface due, for example, to appendicitis or diverticulitis. The tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being disturbed.^[2]

1 Diagnosis
- 1.1 Differential Diagnosis
- 1.2 Laboratory Findings
  - 1.2.1 Electrolyte and Biomarker Studies
- 1.3 MRI and CT
- 1.4 Echocardiography or Ultrasound
- 1.5 Other Imaging Findings
- 1.6 Other Diagnostic Studies
2 Treatment
- 2.1 Pharmacotherapy
3 Surgery and Device Based Therapy
4 References

Diagnosis

Differential Diagnosis

Appendicitis
Pancreatitis
Diverticulitis
Abdominal wall strain/injury
Pelvic inflammatory disease
Ectopic pregnancy
Septic miscarriage (See Miscarriage)
Bowel obstruction
Ileus
Pneumonia
Dyspepsia
Nephrolithiasis
Perforated Peptic ulcer disease
Abdominal aortic aneurysm
Anxiety
Malingering
Spontaneous bacterial peritonitis (SBP)
Mesenteric ischemia
GERD
Ovarian cyst
Hepatic or splenic contusion/laceration
Pneumoperitoneum secondary to abdominal trauma
Urinary tract infection/pyelonephritis
Zoster
- Skin lesions may not be visible until another day or two
Insect toxins (e.g. black widow spider)
Abscess (e.g. iliopsoas)
Incarcerated hernia
Abdominal migraine
Intussusception
Volvulus

Laboratory Findings

Complete blood count (CBC)
Blood urea nitrogen (BUN)/creatinine
Liver function tests (LFTs)
Glucose
Amylase/lipase
Urine culture
Urinalysis
Beta-human chorionic gonadotropin (beta-hCG)
Cervical cultures are recommended to diagnose pelvic inflammatory disease

Electrolyte and Biomarker Studies

Electrolytes

MRI and CT

CT diagnoses:
- Organ contusion
- Organ laceration
- Aneurysm
- Diverticulitis
- Appendicitis

Echocardiography or Ultrasound

Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
- Peritonitis
- Ectopic pregnancy
- Ovarian cysts
- Fluid/blood secondary to trauma
- Appendicitis
- Aneurysm

Other Imaging Findings

KUB x-rays (kidney, ureter, bladder) could reveal nephrolithiasis and bowel gas pattern

Other Diagnostic Studies

Symptomatic relief may be provided by paracentesis, which may also diagnose spontaneous bacterial peritonitis (SBP)
Gastrointestinal endoscopy may be used or patients with suspected peptic ulcer disease
- Helicobacter pylori" testing may also be used
Trial medications may be beneficial for the diagnosis and treatment of:
- GERD/dyspepsia: Proton pump inhibitors or H2 blockers
- Abdominal wall strain: Nonsteriodal anti-inflammatory drugs (NSAIDs)
- Anxiety: Lorazepam
- Zoster: Acyclovir

Treatment

Specific conditions need direct treatment
Hemodynamic status and life-theratening disease require immediate attention
- Volume replacement with a possible blood transfusion, and with normal saline
For obstruction and persistent vomiting, place nasogastric (NG) tube

Pharmacotherapy

If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics

Surgery and Device Based Therapy

Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)

References

Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3

^ Abdominal guarding definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
^ Abdominal Guarding - Abdominal Rigidity on Medicine Online Medical Articles

UpToDate Contents

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1. 小児および思春期における急性腹症の原因 causes of acute abdominal pain in children and adolescents
2. 成人における腹痛の鑑別診断 differential diagnosis of abdominal pain in adults
3. 成人における腹痛に対する診断的アプローチ diagnostic approach to abdominal pain in adults
4. 腹痛を有する成人における既往歴および身体的診察 history and physical examination in adults with abdominal pain
5. 小児における腹部の鈍的外傷の概要 overview of blunt abdominal trauma in children

English Journal

Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios: A manikin study.

Jepsen CH, Gätke MR, Thøgersen B, Mollerup LT, Ruhnau B, Rewers M, Rosenstock CV.SourceFrom the Department of Anaesthesia, Copenhagen University Hospital, Hillerød (JHC, MLT, RCV), Department of Anaesthesiology, Copenhagen University Hospital, Herlev (GRM, TB), Department of Anaesthesia, Centre of Abdominal Surgery, Copenhagen University Hospital, Rigshospitalet (RB) and Danish Institute for Medical Simulation (DIMS), Copenhagen University Hospital, Herlev, Denmark (RM).
European journal of anaesthesiology.Eur J Anaesthesiol.2013 Oct 19. [Epub ahead of print]
BACKGROUND: Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy.OBJECTIVE: The aim of the study was to compare the performance of the
PMID 24145800

New methods of magnet-based instrumentation for NOTES.

Magdeburg R, Hauth D, Kaehler G.SourceDepartment of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg , Mannheim , Germany.
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy.Minim Invasive Ther Allied Technol.2013 Sep 1. [Epub ahead of print]
Abstract Introduction: Laparoscopic surgery has displaced open surgery as the standard of care for many clinical conditions. NOTES has been described as the next surgical frontier with the objective of incision-free abdominal surgery. The principal challenge of NOTES procedures is the loss of triang
PMID 23992384

Transverse colon perforation due to carcinoma rectum: an unusual presentation against Laplace's law.

Sahoo MR, Kumar A, Jaiswal S, C B.SourceDepartment of General Surgery, SCB Medical College, Cuttack, Odisha, India. manash67@gmail.com
BMJ case reports.BMJ Case Rep.2013 Aug 16;2013. pii: bcr2013008561. doi: 10.1136/bcr-2013-008561.
We present a case of distal large bowel obstruction, in the setting of a competent ileocaecal valve, the caecum is the most common site of perforation (for Laplace's law). We describe a case of obstruction at the rectum due to constricting carcinomatous growth, presenting with perforation of transve
PMID 23955978

Japanese Journal

Press through package誤飲によるS状結腸穿孔の1例

藤井研介,新田敏勝,川崎浩資,片岡淳,石橋孝嗣
日本大腸肛門病学会雑誌 68(3), 163-167, 2015
症例は78歳の女性で，発熱，腹痛を主訴に救急搬送された．腹部全体に筋性防御を認め，腹部CTで遊離ガスと腹水を同定し，下部消化管穿孔による腹膜炎と診断し緊急手術を行った．開腹所見では，便汁性腹水の貯留とS状結腸に10mm大の穿孔を同定し，結腸部分切除および人工肛門造設を行った．穿孔部には，ハサミで一包化されたPress through package（以下，PTP）を認め，その鋭利な角で線状潰瘍が形 …
NAID 130004902114

腹腔鏡補助下手術を行った空腸憩室穿孔による汎発性腹膜炎の1例

林晃史,萱島理,山方伸茂,柏木孝仁
日本臨床外科学会雑誌 75(1), 101-105, 2014
症例は77歳，男性．2013年5月上旬に下腹部痛があり，翌日に当院救急外来を受診した．来院時状態は安定しており，臍部から下腹部に圧痛・反跳痛を認めたが，筋性防御はなかった．胃十二指腸潰瘍の既往はなかった．CTでは少量のfree airが上腹部から臍下部まで広範囲に認められたが，穿孔部位の特定は困難であった．部位不明ながら上部消化管穿孔を疑い腹腔鏡下に検索したところ，Treitz靱帯から約20cmの …
NAID 130004679169

腹膜炎を呈し緊急手術を要した回盲部腸間膜デスモイドの1例

三宅美穂,衣笠章一,足立確郎,吉田優子,殿元康仁,常見幸三,田代敬
日本臨床外科学会雑誌 73(7), 1813-1816, 2012
回盲部腸間膜デスモイドの1例を経験したので報告する．症例は63歳男性．入院半月前から下痢が持続し，3日前から生じた右側腹部痛が増強したため当院を受診し腹部CT検査にて回盲部に膿瘍形成を指摘された．身体所見から右下腹部に限局する腹膜炎と診断し急開腹手術となり，術中所見から回盲部切除術を施行した．病理組織診断ではvimentin，β-catenin共に陽性でありデスモイド腫瘍と診断された．患者は第14 …
NAID 130004900803