TABLE 911 Tender Abdomens

Abdominal Wall Tenderness

Visceral Tenderness o o

Superficial tender area

Deep tender areas

Superficial tender area

Deep tender areas

Enlarged liver

Normal cecum

Enlarged liver

Normal cecum

Normal aorta

Normal or spastic sigmoid colon

Normal aorta

Normal or spastic sigmoid colon

Tenderness may originate in the abdominal wall. When the patient raises head and shoulders, this tenderness persists, whereas tenderness from a deeper lesion (protected by the tightened muscles) decreases.

The structures shown may be tender to deep palpation. Usually the discomfort is dull and there is no muscular rigidity or rebound tenderness. A reassuring explanation to the patient may prove quite helpful.

Tenderness From Disease in the Chest and Pelvis

Unilateral or bilateral, upper or lower abdomen

Acute Pleurisy

Abdominal pain and tenderness may be due to acute pleural inflammation. When unilateral, it may mimic acute cholecystitis or appendicitis. Rebound tenderness and rigidity are less common; chest signs are usually present.

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