Decreased bowel sounds

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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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.

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

• Electrolytes

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

Acknowledgements

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