Auscultation provides important information about bowel motility. Listen to the abdomen before performing percussion or palpation, since these maneuvers may alter the frequency ofbowel sounds. You should practice auscultation until you are thoroughly familiar with variations in normal bowel sounds and can detect changes suggestive of inflammation or obstruction. Auscultation may also reveal bruits, vascular sounds resembling heart murmurs, over the aorta or other arteries in the abdomen, which suggest vascular occlusive disease.
Place the diaphragm of your stethoscope gently on the abdomen. Listen for bowel sounds and note their frequency and character. Normal sounds consist of clicks and gurgles, occurring at an estimated frequency of 5 to 34 per minute. Occasionally you may hear borborygmi—long prolonged gurgles of hyperperistalsis—the familiar "stomach growling." Because bowel sounds are widely transmitted through the abdomen, listening in one spot, such as the right lower quadrant, is usually sufficient.
If the patient has high blood pressure, listen in the epigastrium and in each upper quadrant for bruits. Later in the examination, when the patient sits up, listen also in the costovertebral angles. Epigastric bruits confined to systole may be heard in normal persons.
Bowel sounds may be altered in diarrhea, intestinal obstruction, paralytic ileus, and peritonitis. See Table 9-10, Sounds in the Abdomen (p. 362).
A bruit in one of these areas that has both systolic and diastolic components strongly suggests renal artery stenosis as the cause of hypertension.
If you suspect arterial insufficiency in the legs, listen for bruits over the aorta, the iliac arteries, and the femoral arteries. Bruits confined to systole are relatively common, however, and do not necessarily signify occlusive disease.
Listening points for bruits in these vessels are illustrated on p. 334.
If you suspect a liver tumor, gonococcal infection around the liver, or splenic infarction, listen over the liver and spleen for friction rubs.
Bruits with both systolic and diastolic components suggest the turbulent blood flow of partial arterial occlusion. See Table 9-10, Sounds in the Abdomen (p. 362).
See Table 9-10, Sounds in the Abdomen (p. 362).
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...