Symptoms » Stomach cramps » Book Sections

Abdominal rigidity

Detected by palpation, abdominal rigidity refers to abnormal muscle tension or inflexibility of the abdomen. Also known as abdominal muscle spasm or involuntary guarding, 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, page 22.)

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 Actions

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 actions. 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

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. Then explore other signs and symptoms.

Physical assessment

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 to 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 dissecting 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 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

Mesenteric artery ischemia is a life-threatening disorder that’s 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, diarrhea, and constipation. Always suspect mesenteric artery ischemia in patients older than age 50 with 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. Withhold analgesics until a tentative diagnosis has been made because they may mask other symptoms. Also withhold food and fluids and administer an I.V. antibiotic because emergency surgery may be required. 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 children 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 children 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.

Patient counseling

Explain and prepare the patient for diagnostic testing and surgery. Because the patient may be gravely ill, keep your explanations short and simple and take measures to reduce his anxiety.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Stomach cramps

Read excerpts from these other book chapters related to Stomach cramps:

Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

More About Causes of Stomach cramps

• Back to symptom: Stomach cramps: Introduction (review 325 causes)
• Next Book Extract About Stomach cramps: Abdominal Pain (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• All Book Extracts: All Online Book Extracts for Stomach cramps

---

More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

 » Next page: Abdominal Pain (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Abdominal Pain (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• Abdominal Masses (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• Regurgitation and Vomiting (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• Abdominal distention (Nursing: Interpreting Signs and Symptoms)
• Abdominal mass (Nursing: Interpreting Signs and Symptoms)

Tools & Services:

• Bookmark this page
• Take a survey relating to Stomach cramps
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

homepage | back to top

Common Health Mistakes

Choose ... Alzheimers & Dementia Asthma Child ADHD ADHD in Adults Allergy Hypertension Bipolar Breast Cancer Celiac Disease Crohns Disease Colon Cancer Contraception Diabetes Cancer Depression Erectile Disorder Cholesterol COPD GERD Heartburn/Reflux Metabolic Syndrome Migraine/Headache Multiple Sclerosis Obesity Osteoporosis Overactive Bladder Psoriasis Sexual Disorder Sleep Disorders Smoking The Pill Ulcerative Colitis All Common Mistakes

Symptom
Checker

Choose... Fever Rash Pain Headache Fatigue Cough Other symptoms

Search Specialists by State and City

Choose... GENERAL PRACTICE CARDIAC HEALTH WOMEN'S HEALTH CANCER CARE RADIOLOGY MENTAL HEALTH PATHOLOGY EAR, NOSE, THROAT MEDICINE GENETICS NEUROLOGY DIALYSIS CARE SURGERY ORTHOPEDICS/SPORTS MEDICINE CHILDREN'S HEALTH OTHER SPECIALTIES