Which of the following symptoms would a client in the early stages of peritonitis exhibit?
A. Abdominal distention
B. Abdominal pain and rigidity
C. Hyperactive bowel sounds
D. Right upper quadrant pain
Correct Answer: B. Abdominal pain and rigidity
Abdominal pain-causing rigidity of the abdominal muscles is characteristic of peritonitis. During the physical exam, pertinent findings include fever and abdominal tenderness to palpation which usually is diffuse with wall rigidity in more septic presentations.
Option A: Abdominal distention may occur as a late sign but not early on. It is important to conduct a thorough exam as certain thoracic or pelvic pathologies can mimic peritoneal irritation (empyema causing diaphragmatic irritation and cystitis/pyelonephritis causing peritoneum adjacent pain).
Option C: Bowel sounds may be normal or decreased but not increased. Important to note, approximately 30% of individuals with SBP will be asymptomatic on presentation. Patients will present with a variable amount of clinical manifestation of the underlying disease process, ranging from insidious mild limited disease to an acute fulminant systemic process.
Option D: Right upper quadrant pain is characteristic of cholecystitis or hepatitis. Concerning signs present in a high percentage of individuals with diagnosed peritonitis include vague constitutional symptoms such as fever chills, abdominal pain +/- discomfort, diarrhea, and ileus.
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