Abdominal guarding

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]


Differential diagnosis

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

Echocardiography or ultrasound

Other imaging findings

  • KUB x-ray imaging (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


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


  • 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)


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