The clinical features of localised peritonitis are:
a primary intra-abdominal process, e.g. appendicitis
localised abdominal pain - made worse by movement of the abdomen e.g. coughing.
on examination there are signs of localised peritonism:
localised tenderness
contraction of the abdominal muscles over the area of tenderness when palpation is attempted - guarding
rebound tenderness - when the examining hand is quickly examined the movement of the peritoneum causes intense pain. This sign may be better elicited by percussion or asking the patient to cough.
rectal tenderness - anterior tenderness may be elicited
features of mild systemic toxicity, e.g. malaise, low-grade fever, tachycardia, leucocytosis on FBC.
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