A nurse is assessing a client with suspected peritonitis. Which clinical finding is a hallmark sign of this condition?
A.
Severe headache and neck stiffness
B.
Rapid and shallow breathing
C.
Abdominal rigidity and tenderness
D.
Hyperactive bowel sounds
The Correct answer and Explanation is:
The correct answer is:
C. Abdominal rigidity and tenderness
Explanation:
Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of the abdominal organs. It can be caused by a bacterial or fungal infection, often resulting from a rupture in the abdominal cavity, such as a perforated ulcer, a ruptured appendix, or a traumatic injury.
Abdominal Rigidity and Tenderness: The hallmark sign of peritonitis is abdominal rigidity and tenderness. Abdominal rigidity refers to involuntary muscle tightening, which occurs as a protective mechanism against the pain caused by inflammation of the peritoneum. The tenderness is usually generalized but can be localized depending on the underlying cause of the peritonitis. The pain is typically severe, and patients may describe it as sharp or constant. This finding is a critical indicator that distinguishes peritonitis from other abdominal conditions.
Supporting Clinical Findings: Other associated symptoms of peritonitis may include fever, nausea, vomiting, and a significant decline in overall health. Patients with peritonitis often present with a “board-like” abdomen, where the muscles of the abdominal wall are so tense that the abdomen feels hard to the touch. This is a significant clinical finding that warrants immediate medical attention.
Differential Diagnosis:
- Severe headache and neck stiffness (Option A) are not related to peritonitis; these symptoms are more indicative of conditions such as meningitis.
- Rapid and shallow breathing (Option B) can be associated with peritonitis, but it is not specific to the condition and can occur in many acute abdominal and systemic illnesses.
- Hyperactive bowel sounds (Option D) are not typically associated with peritonitis. In fact, bowel sounds may be diminished or absent in cases of severe peritonitis due to paralytic ileus.
Clinical Implications: Recognizing the signs of peritonitis is crucial because this condition is a medical emergency. Left untreated, peritonitis can lead to sepsis, organ failure, and death. Prompt surgical intervention, often accompanied by antibiotic therapy, is required to treat the underlying cause and to manage the infection and inflammation. Therefore, abdominal rigidity and tenderness are key findings that should prompt immediate further investigation and intervention by the healthcare team.