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Symptoms » Digestive symptoms » Book Sections
 

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.

    Other Book Chapters Related to Digestive symptoms

    Read excerpts from these other book chapters related to Digestive symptoms:

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    • Vomiting
    • "In A Page: Pediatric Signs and Symptoms" (2007)
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    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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    • Constipation
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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    • Vomiting
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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    • Constipation
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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    • Nausea and Vomiting
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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    • Vomiting
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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    • Constipation
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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    • Vomiting
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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    • Constipation
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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    • Vomiting
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
     

    Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

    More About Causes of Digestive symptoms



    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

     » Next page: Nausea & Vomiting (In a Page: Signs and Symptoms)

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