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| {{SI}} | | {{Abdominal bruit}} |
| {{CMG}} | | {{CMG}} |
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| == Overview == | | ==[[Abdominal bruit overview|Overview]]== |
| An abdominal bruit is a murmur heard when the diaphragm of [[stethoscope]] is placed over the [[spleen]], [[renal arteries]], or [[abdominal aorta]]. It is often indicative of partial [[stenosis|occlusion of a vessel]], as can be observed in [[renal artery stenosis]] or [[atherosclerosis]] of the abdominal vasculature.
| | ==[[Abdominal bruit historical perspective|Historical Perspective]]== |
| | | ==[[Abdominal bruit pathophysiology|Pathophysiology]]== |
| ==Causes==
| | ==[[Abdominal bruit causes|Causes]]== |
| ===Common Causes=== | | ==[[Abdominal bruit differential diagnosis|Differentiating Abdominal bruit from other Diseases]]== |
| *[[Cirrhosis]]
| | ==[[Abdominal bruit risk factors|Risk Factors]]== |
| *[[Renal artery]] stenosis
| | ==[[Abdominal_bruit_natural_history,_complications_and_prognosis|Natural History, Complications, and Prognosis]]== |
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| ===Complete Differential Diagnosis of the Causes of Abdominal Bruit=== | |
| (In alphabetical order)
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| *[[Abdominal aortic aneurysm]]
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| *Abdominal friction rub
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| *[[Aortic aneurysm]]
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| *[[Arteriovenous malformation]]
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| *[[Celiac artery|Celiac artery stenosis]]
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| *[[Cholangiocarcinoma]]
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| *[[Cirrhosis]]
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| *[[Cruveilhier-Baumgarten murmur]]
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| *[[Fibromuscular dysplasia]]
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| *[[Hepatocellular carcinoma|Hepatocellular carcinoma (hepatic)]]
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| *[[Hepatoma]]
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| *[[Inflammatory processes]]
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| *[[Hemangioma|Liver hemangioma]]
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| *[[Metastases|Liver metastases]]
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| *[[Renal artery stenosis]]
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| *[[Superior mesenteric artery]] stenosis
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| *[[Takayasu's Arteritis]]
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| *[[Tricuspid regurgitation]]
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| *[[Tumor]] that is highly vascularized
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| *Turbulence of the [[splenic artery]]
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| *[[Vasculitis]]
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| ===Complete Differential Diagnosis of the Causes of Abdominal Bruit=== | |
| (By organ system)
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Abdominal aortic aneurysm]], [[Aortic aneurysm]], [[Arteriovenous malformation]], [[celiac artery|Celiac artery stenosis]], [[Tricuspid regurgitation]], Turbulence of the [[splenic artery]], [[Cruveilhier-Baumgarten murmur]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Cirrhosis]], [[Cholangiocarcinoma]], [[Hepatic venous hum]], [[Hepatocellular carcinoma (hepatoma)]], [[Hepatoma]], [[hemangioma|Liver hemangioma]], [[metastases|Liver metastases]], [[Superior mesenteric artery]] stenosis, Turbulence of the [[splenic artery]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Cholangiocarcinoma]], [[Hepatocellular carcinoma (hepatoma)]], [[Hepatoma]], [[metastases|Liver metastases]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| [[Renal artery stenosis]]
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| |-
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| |-bgcolor="LightSteelBlue" | |
| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Inflammatory processes]], [[Takayasu's Arteritis]], [[Vasculitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| Abdominal friction rub
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| |-
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| |}
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| ==Diagnosis== | | ==Diagnosis== |
| === Physical Examination ====
| | :[[Abdominal bruit history and symptoms|History and Symptoms]] | [[Abdominal bruit physical examination|Physical Examination]] | [[Abdominal bruit laboratory findings|Laboratory Findings]] | [[Abdominal bruit abdominal x ray|Abdominal X Ray]] | [[Abdominal bruit CT|CT]] | [[Abdominal bruit MRI|MRI]] | [[Abdominal bruit echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Abdominal bruit other imaging findings|Other Imaging Findings]] | [[Abdominal bruit other diagnostic studies|Other Diagnostic Studies]] |
| | | ==Treatment== |
| ==== Abdomen ====
| | :[[Abdominal bruit medical therapy|Medical Therapy]] | [[Abdominal bruit surgery|Surgery]] | [[Abdominal bruit primary prevention|Primary Prevention]] | [[Abdominal bruit secondary prevention|Secondary Prevention]] | [[Abdominal bruit cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Abdominal bruit future or investigational therapies|Future or Investigational Therapies]] |
| * May have palpable [[thrill]] in addition to the murmur.
| | ==Case Studies== |
| | | :[[Abdominal bruit case study one|Case #1]] |
| === Laboratory Findings ===
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| * [[Captopril]] challenge followed by measuring [[renal vein]] [[renin]] levels diagnoses [[renal artery]] stenosis.
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| * [[Lipid]] panel for [[arteriosclerosis]]
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| * Suspected inflammatory processes:
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| *:* [[Erythrocyte sedimentation rate]] ([[ESR]])
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| *:* [[Complete blood count]]
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| * [[Liver function tests]] ([[LFT]]s) to evaluate liver
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| === MRI and CT ===
| | {{WH}} |
| * [[CT]] of abdomen may be helpful in evaluating underlying [[pathology]].
| | {{WS}} |
| | | [[CME Category::Cardiology]] |
| === Echocardiography or Ultrasound ===
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| * [[Ultrasound]] used as initial test
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| * [[Medical ultrasonography|Arterial Doppler ultrasound]] helps diagnose
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| * [[Echocardiogram]] evaluates valvular dysfunction
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| === Other Imaging Findings ===
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| ==== Angiography ====
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| * Can be used to diagnoses stenoses including [[renal artery stenosis]]
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| === Other Diagnostic Studies ===
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| * IV urography or radionuclide nephrograms will show differences in [[kidney]] perfusion with stenotic artery
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| == Treatment ==
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| * In the critically ill patient with a ruptured [[aortic aneurysm]], the first goal is to stabilize the patient and repair the [[aneurysm]] immediately.
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| * In the patient with [[renal artery stenosis]], the goal is to treat the [[hypertension]]
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| *:* In patients with bilateral stenosis, avoid [[ACE inhibitors]] (always).
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| * Treat underlying [[etiology]]
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| * Consult [[nephrology]] for appropriate management of [[renal insufficiency]]
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| * Consult [[vascular surgery]] for symptomatic and/or severly stenotic vessels
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| == References ==
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| {{Reflist|2}} | |
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| {{SIB}} | |
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| | [[Category:Medical signs]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Nephrology]] | | [[Category:Nephrology]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Physical examination]] | | [[Category:Physical examination]] |
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