Assessment for Peritoneal Inflammation. Abdominal pain and tenderness, especially when associated with muscular spasm, suggest inflammation of the parietal peritoneum. Localize the pain as accurately as possible. First, even before palpation, ask the patient to cough and determine where the cough produced pain. Then, palpate gently with one finger to map the tender area. Pain produced by light percussion has similar localizing value. These gentle maneuvers may be all you need to establish an area of peritoneal inflammation.
Abdominal pain on coughing or with light percussion suggests peritoneal inflammation. See Table 9-11, Tender Abdomens (pp. 363-364).
If not, look for rebound tenderness. Press your fingers in firmly and slowly, and then quickly withdraw them. Watch and listen to the patient for signs of pain. Ask the patient (1) to compare which hurt more, the pressing or the letting go, and (2) to show you exactly where it hurt. Pain induced or increased by quick withdrawal constitutes rebound tenderness. It results from the rapid movement of an inflamed peritoneum.
Rebound tenderness suggests peritoneal inflammation. If tenderness is felt elsewhere than where you were trying to elicit rebound, that area may be the real source of the problem.
B The Liver_
Because most of the liver is sheltered by the rib cage, assessing it is difficult. Its size and shape can be estimated by percussion and perhaps palpation, however, and the palpating hand may enable you to evaluate its surface, consistency, and tenderness.
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