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. 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. Diagnosis
Differential diagnosis
Abdominal aortic aneurysm
Appendicitis
Blunt force trauma to the abdomen
Bowel obstruction
Diverticulitis
Dyspepsia
Ectopic pregnancy
GERD
Ileus
Inflammatory bowel disease
Intussusception
Mesenteric ischemia
Nephrolithiasis
Ovarian cyst
Pancreatitis
Pelvic inflammatory disease
Perforated peptic ulcer disease
Pneumonia
Spontaneous bacterial peritonitis (SBP)
Urinary tract infection/pyelonephritis
Volvulus
Zoster
Skin lesions may not be visible until another day or two
Abdominal migraine
Abdominal wall strain/injury
Abscess (e.g. iliopsoas)
Hepatic or splenic contusion/laceration
Incarcerated hernia
Insect toxins (e.g.
Mees lines or Aldrich–Mees lines, also called leukonychia striata, are white lines of discoloration across the nails of the fingers and toes (leukonychia). Presentation
They are typically white bands traversing the width of the nail. As the nail grows they move towards the end, and finally disappear when trimmed. Causes
Mees lines appear after an episode of poisoning with arsenic, thallium or other heavy metals or selenium, opioid MT-45, and can also appear if the subject is suffering from kidney failure. They have been observed in chemotherapy patients. Eponym and history
Although the phenomenon is named after Dutch physician R. A. Mees, who described the abnormality in 1919, earlier descriptions of the same abnormality were made by Englishman E. S. Reynolds in 1901 and by American C. J. Aldrich in 1904. See also
Leukonychia
List of cutaneous conditions
Muehrckes nails – a similar condition, except the lines are underneath the nails and so do not move as the nail grows

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