Bowel obstruction physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Patients with bowel obstruction usually appear distressed with a distended abdomen with or without fever. Physical examination of patients with bowel obstruction is usually remarkable for tympanic or hyperresonant abdomen, orthostatic hypertension, tachycardia, and dry mucus membrances.

Physical Examination

Physical examination of patients with bowel obstruction is usually remarkable for: tympanic or hyperresonant abdomen, orthostatic hypertension, tachycardia, and dry mucus membrances.

Appearance of the Patient

Patients with bowel obstruction usually appear distressed with sunken eyes.

Vital Signs

• High-grade fever
  • May indicate an infection such as the presence of an abscess, ischemia or necrosis.
• Tachycardia with regular pulse
  • May indicate dehydration
• Low blood pressure with narrow pulse pressure
  • Dehydration may lead to orthostatic hypotension and a decreased urine output

Skin

• Dry mucous membranes
  • May indicate severe dehydration

Abdomen

• Abdominal distention
  • Tympanic, hyperresonant, bowel sounds are hypoactive and fluid thrill may be present
• Abdominal tenderness in the right/left upper/lower abdominal quadrant
• A palpable abdominal mass
  • May be an abscess, volvulus, hernia, tumor or impacted feces
• Abdominal scarrring
  • May indicate previous abdominal surgery
• Hernia
  • Most importanly incisional hernias, also femoral, obturator, umbilical and inguinal hernias that may have strangulated
• Peritoneal signs
  • Including guarding, tenderness and rebound tenderness
• Occult fecal blood
  • With rectal exam, blood may be noted, which suggests late strangulation, incarceration or malignancy

References

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