Physical exam revealed tenderness throughout the lower abdomen with voluntary guarding
. Labarotory data revealed WBC of 12,000/[micro]L, Hgb of 7.8 gm/dL and Hct of 25.7, sodium of 127 mmol/L, and chloride of 96 mmol/L.
There was tenderness to palpation in the left and right lower quadrants with voluntary guarding
, but no distension or rebound tenderness.
The acute abdomen which may require emergent surgery has rebound tenderness, rigidity, and voluntary guarding
. Rebound tenderness is when one pushes down on the abdomen and then lifts up, the pain is worse on releasing pressure.
Abdominal examination revealed right upper quadrant tenderness and voluntary guarding
. Murphy's sign was positive.