Which signs suggest increasing abdominal bleeding?

• A. Abdominal distension only.
• B. Tachycardia without hypotension.
• C. Abdominal distension, guarding, tenderness, rigid abdomen, tachycardia, hypotension.
• D. Nausea but no abdominal signs.

Answer: (C)

The main idea here is recognizing both local abdominal signs and systemic clues that point to ongoing intra-abdominal bleeding. When bleeding increases, blood collects in the abdomen causing distension, while the peritoneum becomes irritated, leading to guarding and tenderness. A rigid abdomen is a concerning peritoneal sign that often appears with advancing hemorrhage. At the same time, the body responds to blood loss with tachycardia as a compensatory mechanism, and if bleeding progresses far enough, blood pressure will fall (hypotension). Seeing all of these signs together—distension plus guarding and tenderness plus a rigid abdomen, along with tachycardia and hypotension—strongly indicates that abdominal bleeding is worsening and needs urgent attention.

Abdominal distension by itself could result from other processes and isn’t definitive for ongoing bleeding. Tachycardia without hypotension can be an early compensatory response and not yet indicate active progression. Nausea with no abdominal signs doesn’t provide reliable evidence of intra-abdominal bleeding.