Decreased bowel sounds: Difference between revisions

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== Differential Diagnosis ==  
== Differential Diagnosis ==  
===Common Causes===
===Common Causes===
*[[Intestinal obstruction]]
*[[Adynamic ileus]]
*[[Intestinal ischemia]]
*[[Peritonitis]]
*[[Acute appendicitis]]
*[[Hypokalemia ]]
*[[Opiates]]


===Causes by Organ System===
===Causes by Organ System===
{|style="width:82%; height:100px" border="1"
{|style="width:82%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Ruptured abdominal aortic aneurysm]], [[Myocardial Infarction]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Radiation]] to the [[abdomen]], [[Phenothiazines]], [[Opiates]],  [[Antihistamines]], [[Anticholinergic]] drugs
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Myxedema]], [[Hypoparathyroidism]], [[Diabetic coma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[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]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Spinal anesthesia]], [[General anesthesia]], [[Bowel]] [[surgery]], [[Anastomotic]] leaks , After [[abdominal]] [[surgery]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Sepsis]], [[Infection]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Spinal cord]] injury
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|Ruptured [[ectopic pregnancy]], [[Pelvic Inflammatory Disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Tumor]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Uremia]], [[Hypomagnesemia]], [[Hypokalemia ]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Abdominal]] [[Trauma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Sleep]], [[Adhesions]], [[Retroperitoneal hemorrhage ]]
|-
|-
|}
|}
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*[[Intestinal ischemia]]
*[[Intestinal ischemia]]
{{ColBreak}}
{{ColBreak}}
*[[Mechanical intestinal obstruction]]
*Mechanical [[intestinal obstruction]]
*[[Mesenteric artery occlusion]]
*[[Mesenteric artery]] occlusion
*[[Myocardial Infarction]]
*[[Myocardial Infarction]]
*[[Myxedema ]]
*[[Myxedema ]]
*[[opiates]] including codeine
*[[opiates]] including codeine
*[[Overexpansion of the bowel]]
*Overexpansion of the [[bowel]]
*[[Pancreatitis]]
*[[Pancreatitis]]
*[[Paralytic (adynamic) ileus]]
*[[Paralytic ileus]]
*[[Pelvic Inflammatory Disease]]
*[[Pelvic Inflammatory Disease]]
*[[Perforated diverticulum]]
*Perforated [[diverticulum]]
*[[Perforated gall bladder]]
*Perforated [[gall bladder]]
*[[Perforated gastric ulcer]]
*Perforated [[gastric ulcer]]
*[[Peritonitis]]
*[[Peritonitis]]
*[[Phenothiazines]]
*[[Phenothiazines]]
*[[Retroperitoneal hemorrhage ]]
*[[Retroperitoneal hemorrhage ]]
*[[Radiation to the abdomen]]
*[[Radiation]] to the [[abdomen]]
*[[Ruptured abdominal aortic aneurysm]]
*Ruptured [[abdominal aortic aneurysm]]
*[[Ruptured ectopic pregnancy]]
*Ruptured [[ectopic pregnancy]]
*[[Sepsis ]]
*[[Sepsis ]]
*[[Sleep]]
*[[Sleep]]
*[[Solid organ injury]]
*Solid organ injury
*[[Spinal anesthesia]]
*[[Spinal anesthesia]]
*[[Spinal cord injury]]
*[[Spinal cord injury]]
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Medical signs]]
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]


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Latest revision as of 17:48, 3 June 2015

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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]


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

Common Causes

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


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

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

Surgery and Device Based Therapy

  • In patients with peritonitis, surgical entervention is usually required

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

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