Point tenderness

Definition

The term point tenderness usually refers to pain felt when pressure is applied over a specific point on the abdomen.

Considerations
The abdomen is an area of the body a doctor can easily examined by touch. The doctor can feel masses and organs within the abdomen and pinpoint where you feel pain.

Abdominal tenderness spans a spectrum from mild tenderness to severe pain. Rebound tenderness occurs when the membrane that lines the abdominal cavity (the peritoneum) is irritated, inflamed, or infected (peritonitis). With peritonitis, the patient will often tense abdominal wall muscles when the abdomen is touched by the doctor. This is called “guarding.” Point tenderness is a more general term which defines tenderness in a particular location.

The most common location that shows point tenderness is McBurney’s point. This is located by drawing a line from the navel to the highest part of the pelvic bone on the right side (iliac crest). Divide the line into three equal lengths. McBurney’s point is 2/3 of the way up from the navel to the iliac crest. Pressure over this point will cause pain in people with symptoms of appendicitis.

Common Causes

• Appendicitis
  
• Incarcerated or strangulated hernia
  
• Ovarian torsion (twisted Fallopian tube)
  
• Pelvic inflammatory disease
  
• Abdominal abscess
  
• Hepatitis
  
• Diverticular disease
  
• Meckel’s diverticulum

What to expect at your health care provider’s office
During the physical examination, the doctor may ask:

• Time pattern
  o When did the Abdominal pain associated with this point tenderness develop?
  o Is this the first time that this kind of discomfort has occurred?
  o If it has occurred before, have you noticed any pattern to the occurrences?
  
• Other
  o What other symptoms are also present?
  o Is there Vomiting?
  o Is there rebound tenderness (the tenderness is worse when the area is gently pressed and then the pressure is suddenly released).
  o Is there diarrhea or Constipation?
  o Is there a fever?
  o Are there fever or chills?
  o Is the person fainting?

• Abdominal film
  
• Abdominal CT scan (occasionally)
  
• Laboratory tests such as a CBC

Sometimes, the physical examination will indicate a need for immediate surgery (an exploratory laparotomy or an emergency appendectomy). This is usually the case if signs of diffuse peritonitis are present.

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