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
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