STUDY - Technical - New Dacian's Medicine
bowel
sounds, abnormal (Classical / Allopathic Medicine)
Absent bowel
sounds refer to an inability to hear bowel sounds through a
stethoscope after listening for at least 5 minutes in each
abdominal quadrant. Bowel sounds cease when a mechanical or
vascular obstruction or neurogenic inhibition halts
peristalsis. When peristalsis stops, gas from bowel contents
and fluid secreted from the intestinal walls accumulate and
distend the lumen, leading to life-threatening complications,
such as perforation, peritonitis, and sepsis, or hypovolemic
shock.
Simple mechanical
obstruction - resulting from adhesions, hernia, or tumor -
causes loss of fluids and electrolytes and induces
dehydration. Vascular obstruction cuts off circulation to the
intestinal walls, leading to ischemia, necrosis, and shock.
Neurogenic inhibition, affecting innervation of the intestinal
wall, may result from infection, bowel distention, or trauma.
Abrupt cessation
of bowel sounds - when accompanied by abdominal pain,
rigidity, and distention - signals a life-threatening crisis
requiring immediate intervention. Absent bowel sounds
following a period of hyperactive sounds are equally ominous
and may indicate strangulation of a mechanically obstructed
bowel.
Sometimes audible
without a stethoscope, hyperactive bowel sounds reflect
increased intestinal motility (peristalsis). They're commonly
characterized as rapid, rushing, gurgling waves of sounds.
They may stem from life-threatening bowel obstruction or GI
hemorrhage as well as from GI infection, inflammatory bowel
disease, food allergies, and stress.
Hypoactive bowel
sounds, detected by auscultation, are diminished in
regularity, tone, and loudness from normal bowel sounds.
Hypoactive bowel sounds result from decreased peristalsis,
which can result from a developing bowel obstruction.
ALERT:
If you fail to detect bowel sounds, assess the patient for abdominal pain and cramping or abdominal distention.
If you detect hyperactive bowel sounds, quickly check the patient's vital signs, and ask the patient about abdominal pain, vomiting, and diarrhea.
If the patient's pain isn't severe or accompanied by other life-threatening signs, perform a focused assessment.
If you fail to detect bowel sounds, assess the patient for abdominal pain and cramping or abdominal distention.
If you detect hyperactive bowel sounds, quickly check the patient's vital signs, and ask the patient about abdominal pain, vomiting, and diarrhea.
If the patient's pain isn't severe or accompanied by other life-threatening signs, perform a focused assessment.
HISTORY:
Ask the patient if he's experiencing abdominal pain. If so, when did it start?
Ask the patient about a sensation of bloating and flatulence. What was the time and nature of his last stool?
Review the patient's medical history, noting especially surgeries, abdominal trauma, acute pancreatitis, diverticulitis, toxic conditions such as uremia, spinal cord injury, and, if the patient is female, gynecologic infection.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Determine whether stress may have contributed to the patient's problem.
Ask about food allergies and recent ingestion of unusual foods or fluids.
Ask the patient if he's experiencing abdominal pain. If so, when did it start?
Ask the patient about a sensation of bloating and flatulence. What was the time and nature of his last stool?
Review the patient's medical history, noting especially surgeries, abdominal trauma, acute pancreatitis, diverticulitis, toxic conditions such as uremia, spinal cord injury, and, if the patient is female, gynecologic infection.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Determine whether stress may have contributed to the patient's problem.
Ask about food allergies and recent ingestion of unusual foods or fluids.
PHYSICAL
ASSESSMENT:
Check the patient's vital signs. Note the presence of a fever.
Inspect abdominal contour to detect localized or generalized distention.
Gently percuss and palpate the abdomen. Palpate for abdominal rigidity and guarding.
Check the patient's vital signs. Note the presence of a fever.
Inspect abdominal contour to detect localized or generalized distention.
Gently percuss and palpate the abdomen. Palpate for abdominal rigidity and guarding.
SPECIAL
CONSIDERATIONS:
If a nasogastric tube is inserted, restrict the patient's oral intake, elevate the head of the bed at least 30 degrees, and turn the patient to facilitate drainage. If an intestinal tube is inserted, refrain from securing the tube to the patient's face, and turn the patient to facilitate the passage of the tube through the GI tract.
If a nasogastric tube is inserted, restrict the patient's oral intake, elevate the head of the bed at least 30 degrees, and turn the patient to facilitate drainage. If an intestinal tube is inserted, refrain from securing the tube to the patient's face, and turn the patient to facilitate the passage of the tube through the GI tract.
PEDIATRIC
POINTERS:
Absent bowel sounds in children may result from Hirschsprung's disease or intussusception, both of which can lead to life-threatening obstructions.
Hyperactive bowel sounds in children usually result from gastroenteritis, erratic eating habits, excessive ingestion of certain foods (such as unripened fruit), or food allergies.
Hypoactive bowel sounds in a child may simply be due to bowel distention from excessive swallowing of air while the child was eating or crying.
Absent bowel sounds in children may result from Hirschsprung's disease or intussusception, both of which can lead to life-threatening obstructions.
Hyperactive bowel sounds in children usually result from gastroenteritis, erratic eating habits, excessive ingestion of certain foods (such as unripened fruit), or food allergies.
Hypoactive bowel sounds in a child may simply be due to bowel distention from excessive swallowing of air while the child was eating or crying.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing. Explain prescribed dietary changes that may be necessary.
Instruct the patient on what to expect from diagnostic testing. Explain prescribed dietary changes that may be necessary.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)