Decreased bowel sounds
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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
Common Causes
- Intestinal obstruction
- Adynamic ileus
- Intestinal ischemia
- Peritonitis
- Acute appendicitis
- Hypokalemia
- Opiates
Causes by Organ System
| Cardiovascular | Ruptured abdominal aortic aneurysm, Myocardial Infarction |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Radiation to the abdomen, Phenothiazines, Opiates, Antihistamines, Anticholinergic drugs |
| Ear Nose Throat | No underlying causes |
| Endocrine | Myxedema, Hypoparathyroidism, Diabetic coma |
| Environmental | No underlying causes |
| Gastroenterologic | Peritonitis, Perforated gastric ulcer, Perforated gall bladder, Perforated diverticulum, Paralytic ileus, Pancreatitis, Overexpansion of the bowel, Mesenteric artery occlusion, Mechanical intestinal obstruction, Intestinal ischemia, Hernia , Hemoperitoneum , Gangrene of the bowel, Enterocolic ulceration, Diverticulitis, Complete bowel obstruction, Cholecystitis, Bowel obstruction, Adynamic ileus, Advanced intestinal obstruction, Acute appendicitis |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | Spinal anesthesia, General anesthesia, Bowel surgery, Anastomotic leaks , After abdominal surgery |
| Infectious Disease | Sepsis, Infection |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | Spinal cord injury |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | Ruptured ectopic pregnancy, Pelvic Inflammatory Disease |
| Oncologic | Tumor |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | Uremia, Hypomagnesemia, Hypokalemia |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | Abdominal Trauma |
| Urologic | No underlying causes |
| Miscellaneous | Sleep, Adhesions, Retroperitoneal hemorrhage |
Causes in Alphabetical Order
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|
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
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
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