Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Absent bowel sounds
Introduction
Overview
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
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
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
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Cafer Zorkun, M.D., Ph.D. [2]