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. [1]
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
Diagnosis
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
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
References
Acknowledgements
The content on this page was first contributed by
List of contributors:
Suggested Reading and Key General References
Suggested Links and Web Resources
For Patients
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
