Decreased bowel sounds

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Overview

 * Sensitivity and specificity of the auscultation of bowel sounds are quite low.
 * Decreased bowel sounds can range from hunger pains to an impending abdominal catastrophe.
 * One must ascultate for a mininum of five minutes before declaring an absence of bowel sounds.

Differential Diagnosis

 * Acute appendicitis
 * Adynamic ileus
 * Benign etiologies
 * Black widow spider bite
 * Complete bowel obstruction
 * Diabetic coma
 * Diverticulitis
 * Hypoparathyroidism
 * Peritonitis
 * Intestinal ischemia
 * Myocardial Infarction
 * Pancreatitis
 * Pelvic Inflammatory Disease
 * Peritonitis
 * Perforated diverticulum
 * Perforated gall bladder
 * Perforated gastric ulcer
 * Rib fractures
 * Ruptured abdominal aortic aneurysm
 * Ruptured ectopic pregnancy
 * Solid organ injury
 * Spinal injury

History and Symptoms

 * Complete history including:
 * Characterization of pain
 * Ascultate before palpation

Physical Examination

 * Complete physical exam including rectal exam

Appearance of the Patient

 * Abdominal guarding, rebound, tenderness and appear very ill (patients with peritonitis)

Laboratory Findings

 * Complete blood count (CBC)
 * Liver function tests (LFTs)
 * Glucose
 * Amylase
 * Blood urea nitrogen (BUN) / creatinine
 * Calcium
 * Lipase
 * Urinalysis

Electrolyte and Biomarker Studies

 * Electrolytes

MRI and CT

 * CT scan (abdominal) may be indicated

Echocardiography or Ultrasound

 * Ultrasound may be indicated for gynecologic concerns

Treatment

 * Treatment should not be based solely on bowel sounds
 * Treatment specific to underlying etiology
 * For those patients with ileus, bowel rest and IV hydration
 * Ambulation is suggested
 * Correct electrolytes
 * Discontinue use of constipating drugs
 * Nasogastric decompression

Acute Pharmacotherapies

 * Prokinetic drugs (ileus)

Surgery and Device Based Therapy

 * In patients with peritonitis, surgical entervention is usually required

Acknowledgements
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