Guarding
Formal Definition
Involuntary or voluntary muscular rigidity of the abdominal wall on palpation, occurring as a protective response to peritoneal irritation or underlying abdominal pathology.
How It's Used on the Ward
"She's guarding" — felt as tensing of the abdominal muscles when you push. Involuntary guarding = peritonitis until proven otherwise.
Example
""Abdomen: soft, tender in the RLQ with voluntary guarding and rebound tenderness at McBurney's point. Working diagnosis: appendicitis. Surgery consulted.""
Clinical Context
Distinguish voluntary (patient bracing against anticipated pain) from involuntary (reflex muscular rigidity you cannot relax even with distraction). Involuntary guarding = peritoneal irritation — this is a surgical abdomen sign. Accompanied by rebound tenderness (pain worse on release than on pressure), it strongly suggests peritonitis. Distract the patient with conversation during the exam to differentiate.
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