Overview
- Auscultation for the character of the bowel sounds may reveal evidence of hyperactive or underactive bowels.
Bowel Sounds
How to Assess
- Auscultate the abdomen for bowel sounds. First listen in one quadrant and if an abnormality is discovered then listen in each of the three other quadrants.
- In order to be sure that bowel sounds are absent, it is important to listen for at least five minutes.
Interpretation
- Gurgling sounds: movement of gas and fluid via peristalsisNormal
- Borborygmi: loud rumbling sounds due to movement of air within the gutNormal
- Hypoactive: diminished or absent bowel soundsPeritonitis, proximal obstruction, ileus, ischaemia
- Hyperactive: extremely increased bowel soundsGastroenteritis, laxatives, IBD, bowel obstruction
- Hollow, high pitched tinkles: similar to rain on a tin roof, due to liquid and gas under pressure within dilated gutCharacteristic of small bowel obstruction
Succussion Splash
- In patients with gastric outlet obstruction, a succussion splash will be heard on percussion of the abdomen due to excessive fluid in the stomach.
How to Elicit
- Auscultate the abdomen while rapidly tapping over the epigastrium, listening for a splashing sound.
Causes of Succussion Splash
- Peptic ulcer
- Ingestion of caustic chemicals
- Pancreatitis
- Crohn’s disease
- Gastric polyp
- Hypertrophic pyloric stenosis
- Bezoar
- Cancer - gastric, pancreatic, bile duct
- Hydropneumothorax
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------