Learn how to auscultate the abdomen to assess bowel sounds and bruits in patients presenting with abdominal pain. Auscultation of the abdomen involves using a stethoscope to listen to and generally assess bowel sounds and bruits (i.e., murmurs). Let’s review how to auscultate the abdomen during an abdominal exam, with a focus on how to listen for bowel sounds and bruits. How to auscultate the abdomen for bowel soundsWhen performing auscultation of the abdomen, use the diaphragm of your stethoscope. Warm up the diaphragm of your stethoscope by placing it in your hands; this makes it more comfortable when laid on the patient’s skin. Listen for bowel sounds in the abdomen to the right of the umbilicus where the midportion of the small bowel is located. Then, proceed to listen to all four quadrants. Figure 1. When auscultating the abdomen, first listen for bowel sounds to the right of the umbilicus, and then listen to all four quadrants. Check out this short video clipAbnormal pitch and frequencyNormally, bowel sounds consist of low-pitched gurgling sounds that occur every five to ten seconds with peristalsis (i.e., bowel movement). An absence of bowel sounds for greater than two minutes may indicate that there is no peristalsis—which implies an ileus. Very high-pitched bowel sounds can be associated with mechanical obstruction, such as a small bowel obstruction. Small obstructions increase the volume and frequency of bowel sounds. Table 1. Pitch and frequency of bowel sounds under normal conditions, with an ileus, and when a small bowel obstruction is present. Become a great clinician with our video courses and workshopsHow to auscultate the abdomen for bruitsAuscultation for bruits is an important part of the abdominal exam. A bruit is an abnormal swishing or blowing sound from blood flowing through a narrowed or partially occluded artery. It can be thought of as a vascular murmur. Where to check for abdominal bruitsDuring an abdominal exam, you should attempt to auscultate a bruit over five structures:
Figure 2. When auscultating the abdomen for bruits auscultate over five key structures including the aorta, the renal arteries (bilaterally), the iliac arteries (bilaterally), the hepatic artery, and the splenic artery. AortaTo auscultate the aorta, place the stethoscope between the xiphoid (epigastrium) and the umbilicus about two-thirds of the way down. Bilateral renal arteriesPlace the stethoscope about 3 cm superior and lateral to the umbilicus on both the left and right sides for the bilateral renal arteries. On some people, this can be approximated by drawing an imaginary line down from the point just proximal to the midclavicular line. Bilateral iliac arteriesTo auscultate the bilateral iliac arteries, place the stethoscope about 3 cm inferior and lateral to the umbilicus on the left and right sides. Here’s a short videoHepatic arteryFor the hepatic artery, place the stethoscope along the right subcostal margin laterally at approximately the midclavicular line. Splenic arteryWhen auscultating the splenic artery, place the stethoscope along the left subcostal margin, approximately 2 cm inferior and lateral (moving posteriorly) to the midclavicular line. This accounts for the posterior location of the spleen. That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients. Recommended reading
About the author Breast Surgical Oncologist at Johns Hopkins Howard County General Hospital and Assistant Professor of Surgery at Johns Hopkins University Hospital, Maryland, USA When Auscultating the abdomen for bowel sounds How long should you listen before concluding that bowel sounds are absent?In order to conclude that bowel sounds are absent, one must listen for three to five minutes (and hear nothing). Be sure to pick up the stethoscope as you move from quadrant to quadrant (do not drag it across the abdomen).
How long must you listen to establish the absence of bowel sounds?When bowel sounds are not present, one should listen for a full 3 minutes before determining that bowel sounds are, in fact, absent. Auscultation for abdominal bruits is the next phase of abdominal examination.
How long should the nurse listen before reporting absent bowel sounds?Auscultation should begin in the right lower quadrant. If bowel sounds are not heard, in order to determine if bowel sounds are truly absent, listen for a total of five minutes (Jarvis, 2011). Bowel sounds echo the underlying movements of the intestines.
What is the correct pattern for Auscultating bowel sounds?◂ Auscultate for bowel sounds. Begin in the right lower quadrant (RLQ), and move in sequence up to the right upper quadrant (RUQ), left upper quadrant (LUQ), and finally the left lower quadrant (LLQ). Auscultate for bruits over the aorta, renal arteries, iliac arteries, and femoral arteries.
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When auscultating the abdomen for bowel sounds How long should you listen before concluding that bowel sounds are absent quizlet?
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