When Continuing to Assess the Abdominal Area the Nurse Hears a Swishing Sound
How to auscultate the abdomen
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 sounds
When 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 clip
Abnormal pitch and frequency
Normally, 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.
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How to auscultate the abdomen for bruits
Auscultation 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 bruits
During an abdominal exam, you should attempt to auscultate a bruit over five structures:
- Aorta
- Bilateral renal arteries
- Bilateral iliac arteries
- Hepatic artery
- Splenic artery
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.
Aorta
To auscultate the aorta, place the stethoscope between the xiphoid (epigastrium) and the umbilicus about two-thirds of the way down.
Bilateral renal arteries
Place 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 arteries
To 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 video
Hepatic artery
For the hepatic artery, place the stethoscope along the right subcostal margin laterally at approximately the midclavicular line.
Splenic artery
When 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.
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Recommended reading
- de Dombal, FT. 1988. The OMGE acute abdominal pain survey. Progress report, 1986.Scand J Gastroenterol Suppl.144: 35–42. PMID: 3043646
- Jin, XW, Slomka, J, and Blixen, CE. 2002. Cultural and clinical issues in the care of Asian patients.Cleve Clin J Med.69: 50, 53–54, 56–58. PMID: 11811720
- Tseng, W-S and Streltzer, J. 2008. "Culture and clinical assessment". In:Cultural Competence in Health Care. Boston: Springer.
- Wong, C. 2020. Liver fire in traditional Chinese medicine.verywellhealth. https://www.verywellhealth.com
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
Source: https://www.medmastery.com/guides/abdominal-examination-clinical-guide/how-auscultate-abdomen
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