Peritonitis means inflammation of the peritoneum.
In contrast to visceral pain, the parietal peritoneum is innervated by somatic nerves and
hence pain is accurately localised to the site of inflammation.
This type of pain is typically worse with movement, coughing or inspiration and therefore
the patient lies still with shallow breaths (unlike colicky pain, where he moves about to try
to get comfortable).
Peritonitis is associated with guarding or rigidity of the abdominal muscles.
There appears to be some difference in opinion as to the true definition of guarding and
rigidity; however, most surgeons would agree that guarding is an involuntary (reflex)
contraction of the abdominal muscles when the examining hand presses down over the inflamed area.
It is sometimes difficult to differentiate true guarding from voluntary guarding, where the
patient contracts his own abdominal muscles in anticipation of pain (especially seen
in children). However, if you palpate the two sides of the abdomen at thesame time while
distracting the patient, you may find that the muscles appear tense on one side compared to
the other. It is not really possible to do this voluntarily (where the two sides contract
symmetrically) and hence this must be true guarding. If at rest the patient’ s abdominal
musculature has an increased tone, then this is termed rigidity and is again due to
underlying inflammation of the peritoneum. If peritonitis involves thewhole abdomen, then
the patient would typically present with a boardlike, rigid, tender abdomen with absent bowel sounds.
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