Of the four pathologic processes—inflammation, hemorrhage, torsion, and colic—responsible for an acute abdomen, inflammation is by far the most common. Specific conditions such as acute appendicitis, acute cholecystitis, and perforated duodenal ulcer are associated with peritoneal inflammation, the extent and severity of which varies. Regardless of the underlying conditions responsible for peritonitis, the features of peritoneal irritation remain the same: pain, tenderness, rebound tenderness, and muscle spasm. Identifying the area of peritoneal irritation provides a clue to the probable structure involved in the inflammatory process. For example, inflammation resulting from causes as diverse as acute appendicitis, cecal diverticulitis, perforation of cecal carcinoma, Meckel’s diverticulitis, and acute regional enteritis of the terminal ileum is associated with pain, tenderness, rebound tenderness, and muscle spasm in the right lower quadrant. Signs of inflammation in the right upper quadrant should lead one to suspect that the problem arises from the gallbladder, liver, duodenum, head of the pancreas, hepatic flexure of the colon, or right kidney—structures normally present in that area.
KeywordsPeritoneal Cavity Acute Appendicitis Muscle Spasm Parietal Peritoneum Perforated Ulcer
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