Bowel Sounds - Increased
Despite extensive efforts to evaluate and classify the sounds of the bowel using advanced technology, correlation of sounds to physiology using manometry and/or auscultation, meaningful interpretation of bowel sounds remains clinically futile. The overused phrase “bowel sounds normal” has little to contribute to the clinical decision-making process in the practice of medicine today.
Differential Diagnosis
- Benign etiologies
–Variation of normal (5–30 sounds per
minute)
–Recent meal
–Borborygmi (“stomach growling”): Loud,
rumbling and gushing sounds due to movement of large amounts of fluid and air
–Air swallowing
- Mechanical bowel obstruction: May present with distension, hiccups, nausea/vomiting, crampy abdominal pain or spasms, constipation, or watery diarrhea
–Adhesions from prior surgery (cause 60% of cases)
–Neoplasms (20%): May be extra- or intraluminal
–Hernias (10%): May be external (inguinal, femoral, ventral) or internal (diaphragmatic, congenital, mesenteric defects)
–Crohn's disease (5%)
–Abscess
–Volvulus
–Intussusception (rare in adults)
–Colonic pseudo-obstruction (Ogilvie's
syndrome)
-
Diarrhea
–Acute gastroenteritis
–Malabsorption syndrome
–Lactase deficiency
–Infection
-
Succussion splash: Large collection of stagnant air and fluid in the distal stomach secondary to a gastric outlet obstruction, gastroparesis, or recent large meal may be auscultated while vigorously shaking the patient
-
Gallstone ileus
-
Peutz-Jeghers syndrome: Polypoid hamartoma of the bowel resulting in intussusception
-
Foreign body
-
Carcinoid syndrome
-
Hiatal hernia
Workup and Diagnosis
A careful history and physical exam are crucial, including
rectal exam
–Vital sign assessment for fever and dehydration
–Bowel sounds should be auscultated before palpation
–Hyperactive, high-pitched “tinkles” or “rushes”
(“cathedral” sounds) often occur with obstruction
–Abdominal examination should include all hernia orifices and evaluate for signs of incarceration and strangulation
-
Initial labs should include CBC, electrolytes, BUN/creatinine, glucose, calcium, liver function tests, amylase, lipase, and urinalysis
-
Flat and upright (or decubitus) abdominal X-rays are helpful to diagnose obstructions
-
Abdominal CT scan is the most useful test and may demonstrate the etiology
-
Enteroclysis is helpful to determine the level and degree of obstruction
Treatment
-
Aggressive replacement of fluids and electrolytes is crucial
-
Complete bowel obstruction with signs of strangulation (e.g., fever, leukocytosis, peritonitis) requires emergent operative intervention
–Highly selected patients with complete obstruction and no peritonitis may be managed conservatively for a short period of time, but risk development of strangulation
Partial small bowel obstructions can usually be managed conservatively by nasogastric decompression, no oral intake, and IV fluids
–Serial evaluations are required to detect progression to complete obstruction
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Digestive symptoms
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Nausea & Vomiting (In a Page: Signs and Symptoms)
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