Health Questions and Answers

QUESTION: Which tests for peritoneal irritation are best?

Rebound tenderness
is the traditional physical examination finding for peritonitis• In a patient with likely generalized peritonitis (obvious distress, an excruciating pain every time the ambulance hits a bump), the standard tests for rebound tenderness are unnecessarily harsh. Asking the patient to cough generally supplies adequate peritoneal motion to give a positive test. When in every respect the examination is normal, one highly sensitive test for peritoneal irritation is the heel-drop jarring test. The patient is asked to stand, rise up on tiptoe with knees straight, and forcibly drop down on both heels with an audible thump• Among patients with appendicitis, this test was found to be 74% sensitive, compared with 64% for the standard rebound test.

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