Bowel sounds, hyperactive

Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They're commonly characterized as rapid, rushing, gurgling waves of sounds. (See Characteristics of bowel sounds.) They may stem from life-threatening bowel obstruction or GI hemorrhage or from GI infection, inflammatory bowel disease (which usually follows a chronic course), food allergies, or stress.

Emergency interventions

After detecting hyperactive bowel sounds, quickly check the patient's vital signs and ask him about associated symptoms, such as abdominal pain, vomiting, and diarrhea. If he reports cramping abdominal pain or vomiting, continue to auscultate for bowel sounds. If bowel sounds stop abruptly, suspect complete bowel obstruction. Prepare to assist with GI suction and decompression, to give I.V. fluids and electrolytes, and prepare the patient for surgery.

If he has diarrhea, record its frequency, amount, color, and consistency. If you detect excessive watery diarrhea or bleeding, prepare to administer an antidiarrheal, I.V. fluids and electrolytes and, possibly, blood transfusions.

GENDER CUE:Homosexual males who report acute diarrhea and who have negative fecal ova and parasite cultures may be infected with chlamydial proctitis not associated with lymphogranuloma venereum. Because rectal cultures will probably be negative, treatment with tetracycline is appropriate.

History and physical examination

If you've ruled out life-threatening conditions, obtain a detailed medical and surgical history. Ask the patient if he has had a hernia or abdominal surgery because these may cause mechanical intestinal obstruction. Does he have a history of inflammatory bowel disease? Also, ask about recent eruptions of gastroenteritis among family members, friends, or coworkers. If the patient has traveled recently, even within the United States, was he aware of any endemic illnesses?

In addition, determine whether stress may have contributed to the patient's problem. Ask about food allergies and recent ingestion of unusual foods or fluids. Check for fever, which suggests infection. Having already auscultated, now gently inspect, percuss, and palpate the abdomen.

Medical causes

❑ Crohn's disease. Hyperactive bowel sounds usually arise insidiously. Associated signs and symptoms include diarrhea, cramping abdominal pain that may be relieved by defecation, anorexia, a low-grade fever, abdominal distention and tenderness and, in many cases, a fixed mass in the right lower quadrant. Perianal and vaginal lesions are common. Muscle wasting, weight loss, and signs of dehydration may occur as Crohn's disease progresses.

❑ Food hypersensitivity. Malabsorption — typically lactose intolerance — may cause hyperactive bowel sounds. Associated signs and symptoms include diarrhea and, possibly, nausea and vomiting, angioedema, and urticaria.

❑ Gastroenteritis. Hyperactive bowel sounds follow sudden nausea and vomiting and accompany “explosive” diarrhea. Abdominal cramping or pain is common, usually after a peristaltic wave. Fever may occur, depending on the causative organism.

❑ GI hemorrhage. Hyperactive bowel sounds provide the most immediate indication of persistent upper GI bleeding. Other findings include hematemesis, coffee-ground vomitus, abdominal distention, bloody diarrhea, rectal passage of bright red clots and jellylike material or melena, and pain during bleeding. Decreased urine output, tachycardia, and hypotension accompany blood loss.

❑ Mechanical intestinal obstruction. Hyperactive bowel sounds occur simultaneously with cramping abdominal pain every few minutes in patients with mechanical intestinal obstruction, a potentially life-threatening disorder; bowel sounds may later become hypoactive and then disappear. With small-bowel obstruction, nausea and vomiting occur earlier and with greater severity than in large-bowel obstruction. With complete bowel obstruction, hyperactive sounds are also accompanied by abdominal distention and constipation, although the part of the bowel distal to the obstruction may continue to empty for up to 3 days.

❑ Ulcerative colitis (acute). Hyperactive bowel sounds arise abruptly in patients with ulcerative colitis and are accompanied by bloody diarrhea, anorexia, abdominal pain, nausea and vomiting, fever, and tenesmus. Weight loss, arthralgias, and arthritis may occur.

Special considerations

Prepare the patient for diagnostic tests. These may include endoscopy to view a suspected lesion, barium X-rays, or stool analysis. An increased white blood cell count may indicate an infection.

Pediatric pointers

Hyperactive bowel sounds in children usually result from gastroenteritis, erratic eating habits, excessive ingestion of certain foods (such as unripened fruit), or food allergy.

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Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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