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]

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

Common Causes

• Intestinal obstruction
• Adynamic ileus
• Intestinal ischemia
• Peritonitis
• Acute appendicitis
• Hypokalemia
• Opiates

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
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

Abdominal Trauma Abdominopelvic abscess Acute appendicitis Adhesions Advanced intestinal obstruction Adynamic ileus After abdominal surgery Anastomotic leaks Anticholinergic drugs Antihistamines Bowel obstruction Bowel surgery Chemical imbalances such as hypokalemia Cholecystitis Complete bowel obstruction Diabetic coma Diverticulitis Enterocolic ulceration Gangrene of the bowel General anesthesia Hemoperitoneum Hernia Hypokalemia Hypomagnesemia Hypoparathyroidism Infection Intestinal ischemia

Mechanical intestinal obstruction Mesenteric artery occlusion Myocardial Infarction Myxedema opiates including codeine Overexpansion of the bowel Pancreatitis Paralytic ileus Pelvic Inflammatory Disease Perforated diverticulum Perforated gall bladder Perforated gastric ulcer Peritonitis Phenothiazines Retroperitoneal hemorrhage Radiation to the abdomen Ruptured abdominal aortic aneurysm Ruptured ectopic pregnancy Sepsis Sleep Solid organ injury Spinal anesthesia Spinal cord injury Tumor Uremia

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

References

Acknowledgements

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List of contributors:

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