Rule Out Rebound Tenderness

In a patient with abdominal pain, it should be determined whether rebound tenderness is present. Rebound tenderness is a sign of peritoneal irritation and can be elicited by palpating deeply and slowly in an abdominal area away from the suspected area of local inflammation.

Figure 17-23 Technique for liver palpation.

The palpating hand is then quickly removed. The sensation of pain on the side of the inflammation that occurs on release of pressure is rebound tenderness. If generalized peritonitis is present, pain is felt in the area of palpation. The patient should be asked, ''Which hurts more, now (while pressing) or now (during release)?'' This is a useful test, but because generalized pain is elicited in the patient with peritonitis, the maneuver should be performed near the conclusion of the abdominal examination.

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