The nurse performs an initial abdominal assessment on a patient newly admitted for abdominal pain. The nurse hears what she describes as “clicks and gurgles in all four quadrants” as well as “swishing or buzzing sound heard in one or two quadrants.” Which of the following statements is correct?
A. The frequency and intensity of bowel sounds varies depending on the phase of digestion.
B. In the presence of intestinal obstruction, bowel sounds will be louder and higher pitched.
C. A swishing or buzzing sound may represent the turbulent blood flow of a bruit and is not normal.
D. All of the above.
Correct Answer: D. All of the above.
All of the statements are true. Abdominal examination can give diagnostic clues regarding most gastrointestinal and genitourinary pathologies and may also give insight regarding abnormalities of other organ systems. A well-performed abdominal examination decreases the need for detailed radiological investigations also plays an important role in patient management.
Option A: The gurgles and clicks described in the question represent normal bowel sounds, which vary with the phase of digestion. The diaphragm of the stethoscope should be placed on the right side of the umbilicus to listen to the bowel sounds, and their rate should be calculated after listening for at least two minutes. Normal bowel sounds are low-pitched and gurgling, and the rate is normally 2-5/min.
Option B: Intestinal obstruction causes the sounds to intensify as the normal flow is blocked by the obstruction. Absent bowel sounds may indicate paralytic ileus and hyperactive rushes (borborygmi) are usually present in small bowel obstruction and sometimes may be auscultated in lactose intolerance
Option C: The swishing and buzzing sound of turbulent blood flow may be heard in the abdomen in the presence of abdominal aortic aneurysm, for example, and should always be considered abnormal. The diaphragm should be placed above the umbilicus to listen for an aortic bruit and then moved 2 cm above and lateral to the umbilicus to listen for a renal bruit. The presence of the former indicates an abdominal aortic aneurysm and the latter indicates renal artery atherosclerosis.