Bowel Sounds – Increased

Normal bowel sounds (BS) are intermittent low-to-medium-pitched gurgles interspersed with occasional high-pitched, tinkling metallic sounds heard every 10–30 seconds. In acute intestinal obstruction (mostly small bowel) the BS are markedly increased. High frequency, loud low-pitched gurgles (borborygmi), often rising to a high-pitched crescendo that coincides with colicky abdominal pain is pathognomonic of small bowel obstruction. This represents bouts of peristaltic activity that occurs in an attempt to “overcome” the obstruction.

Differential Diagnosis

• Hypertrophic pyloric stenosis (HPS)
  –Most common cause in the neonate, between second and eighth week of life
  –Typically nonbilious vomiting
  –Most common in first-born males
  –25% of offspring of affected female will have HPS
  –Increased among blood groups B and O

• Mechanical intestinal obstruction
  –Small bowel obstruction is most common
  –May be congenital or acquired
  –May be partial or complete
  –Simple or strangulating (bowel ischemia)
• Congenital small bowel obstruction
  –Incidence 1/1,500 live births
  –Malrotation with or without volvulus
  –Duodenal atresia/stenosis (common in infants with Down syndrome)
  –Jejunal, ileal atresia/stenosis
  –Annular pancreas
  –Intestinal duplication
  –Intra-abdominal hernia
  –Meconium ileus (common in CF)
• Acquired small bowel obstruction
  –Intussuception
  –Incarcerated inguinal hernia
  –Postsurgical adhesions
  –Duodenal hematoma (post traumatic)
  –Ascariasis: Heavy infestation, with formation of obstructing ball of worms
  –Crohn disease (stricture)
  –SMA syndrome
• Colonic obstruction
  –Bowel sounds usually not very increased
  –Hirschsprung disease
  –Small left colon syndrome (seen in infants of diabetic mothers)
  –Adhesions (post-NEC)
  –Fibrosing colonopathy (seen in CF)
  –Chagas disease
• Acute gastroenteritis
• Drugs
  –Prokinetic agents: Metoclopramide, erythromycin
• Early peritonitis
  –High-pitched, high frequency
• Intestinal pseudo-obstruction

Workup and Diagnosis

• History
  –Age of onset, PMH, PSH, history of trauma
  –Bilious/nonbilious, projectile/nonprojectile vomiting
  –Diarrhea, last wet diaper, mental state
  –Colicky abdominal pain
  –Travel history
  –Medications
  –Maternal history: Polyhydramnios, gestational DM
• Physical examination
  –Vital signs, anthropometry measurements
  –Signs of dehydration
  –Abdominal exam: Visible peristalsis waves (with pyloric stenosis), tenderness, masses (epigastric olive mass in HPS)
  –Inguinal exam for incarcerated hernia
• Labs
  –Electrolytes (hypochloremic metabolic alkalosis in HPS)
  –Amylase and lipase to rule out pancreatitis
  –CBC: Leukocytosis and thrombocytopenia with metabolic acidosis is highly suggestive of bowel infarction
  • Studies
    –Obstructive series
    –Abdominal ultrasound (for HPS and intussuception)
    –Upper GI series or CT when obstructive series and ultrasounds fail to pinpoint site of obstruction

Treatment

Fluid resuscitation and stabilization of the patient in the presence of intestinal obstruction
–Make the patient NPO
–Nasogastric tube decompression prevents vomiting
–Cultures and antibiotics
–Children with bowel ischemia often present in sepsis and shock
–Neonates with bowel obstruction and children with suspected strangulating obstruction should also receive antibiotics

• Immediate surgical intervention for relief of obstruction to prevent bowel ischemia and gangrene
• Treatment is directed at underlying cause in nonsurgical cases

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Digestive symptoms

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

Medical Books Excerpts

• CONSTIPATION
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
• [ read ]

• NAUSEA AND VOMITING
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
• [ read ]

• Constipation
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Bowel Sounds - Decreased
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Bowel Sounds - Increased
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Nausea & Vomiting
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Constipation
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• Vomiting
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• Bowel Sounds – Decreased
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• Bowel Sounds – Increased
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• Vomiting – Projectile
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• CONSTIPATION
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• NAUSEA AND VOMITING
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• Bowel sounds, hyperactive
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Bowel sounds, hypoactive
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Constipation
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Peristaltic waves, visible
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Vomiting
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Bowel sounds, absent [Silent abdomen]
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Constipation
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Bibliography: Gastrointestinal and Hepatic Systems
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Gastrointestinal Bleeding
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Gastrointestinal Complications of HIV
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Nausea and Vomiting*
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Intestinal obstruction
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Introduction: Gastrointestinal Disorders
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Irritable bowel syndrome
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Bowel sounds, hyperactive
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Bowel sounds, hypoactive
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Constipation
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Peristaltic waves, visible
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Vomiting
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Bowel sounds, absent [Silent abdomen]
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Constipation
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Gastrointestinal Bleeding
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Nausea and Vomiting
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Constipation
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Gastrointestinal Bleeding
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Nausea/Vomiting
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Intestinal obstruction
• "Handbook of Diseases" (2003)
• [ read ]

• Irritable bowel syndrome
• "Handbook of Diseases" (2003)
• [ read ]

• Chronic constipation
• "Handbook of Diseases" (2003)
• [ read ]

• Bowel sounds, hyperactive
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Vomiting
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Bowel sounds, absent
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Bowel sounds, hyperactive
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Bowel sounds, hypoactive
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Constipation
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Peristaltic waves, visible
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Vomiting
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Bowel sounds, absent
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Constipation
• "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
• [ read ]

• Gastrointestinal Bleeding
• "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
• [ read ]

• Regurgitation and Vomiting
• "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
• [ read ]

• Bowel sounds, hyperactive
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Bowel sounds, hypoactive
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Constipation
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Peristaltic waves, visible
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Vomiting
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Bowel sounds, absent [Silent abdomen]
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• CONSTIPATION
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• NAUSEA AND VOMITING
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

 

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

More About Causes of Digestive symptoms

• Back to symptom: Digestive symptoms: Introduction (review 4397 causes)
• Next Book Extract About Digestive symptoms: Vomiting – Projectile (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Digestive symptoms

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More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Vomiting – Projectile (In A Page: Pediatric Signs and Symptoms)

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