Abdomen auscultation

(Eliudi Kituma) #1

Hi am Elly… A medical student in Tanzania :tanzania:

Please i need help on

  1. important regions to ascultate during abdominal examination and
  2. possible sounds that can be heard in normal condition and in abnormal condition

(Max Jahanzad) #2

Hey Eliudi,
In brief, you have to check all areas of the abdomen, as we are not looking for bowel sound only.
Regarding the abdominal sounds, I can classify them in three main groups:

1- Bowel sounds:
These are low-pitched gurgling sounds produced by normal gut peristalsis. Listen with the diaphragm of the stethoscope just below the umbilicus.
• Normal: low-pitched gurgling, intermittent
• High-pitched: often called tinkling. These sounds are suggestive of partial or total bowel obstruction.
• Borborygmus: a loud, low-pitched gurgling that can even be heard without a stethoscope. (The sounds are called borborygmi.) These are typical of diarrheal states or abnormal peristalsis.
• Absent sounds: If no sounds are heard for 2 minutes, there may be a complete lack of peristalsis—i.e., paralytic ileus or peritonitis.

2- Bruits
These are sounds produced by the turbulent flow of blood through a vessel—similar in sound to heart murmurs. Listen with the diaphragm of the stethoscope.
Bruits may occur in normal adults but raise the suspicion of pathological stenosis (narrowing) when heard throughout both systole and diastole.
There are several areas you should listen to on the abdomen:
• Just above the umbilicus over the aorta (abdominal aortic aneurysm)
• Either side of midline just above the umbilicus (renal artery stenosis)
• At the epigastrium (mesenteric stenosis)
• Over the liver (AV malformations, acute alcoholic hepatitis, hepatocellular carcinoma)

3- Friction Rubs
These are creaking sounds like that of a pleural rub heard when inflamed peritoneal surfaces move against each other with respiration.
Listen over the liver and spleen in the right and left upper quadrants, respectively.
Causes include hepatocellular carcinoma, liver abscesses, recent percutaneous liver biopsy, liver or splenic infarction, and STI-associated perihepatitis (Fitz–Hugh–Curtis syndrome).

4- Venous hums
Rarely, it is possible to hear the hum of venous blood flow in the upper abdomen over a caput medusa secondary to portosystemic shunting of blood.


(Eliudi Kituma) #3

Thanks very much Max… Amazing summary will help me a lots :grinning::pray:

(Lewis Potter) #4

Thanks for providing such a good summary Max!