Bowel sounds, hyperactive
Bowel sounds, hyperactive: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They’re commonly characterized as rapid, rushing, gurgling waves of sounds. (See Characteristics of bowel sounds.) They may stem from life-threatening bowel obstruction or GI hemorrhage or from GI infection, inflammatory bowel disease (which usually follows a chronic course), food allergies, or stress. (See Hyperactive bowel sounds: Causes and associated findings, page 116.)
Emergency interventions
After detecting hyperactive bowel sounds, quickly check vital signs and ask the patient about associated symptoms, such as abdominal pain, vomiting, and diarrhea. If he reports cramping abdominal pain or vomiting, continue to auscultate for bowel sounds. If bowel sounds stop abruptly, suspect complete bowel obstruction. Prepare to assist with GI suction and decompression and to give I.V. fluids and electrolytes, and prepare the patient for surgery.
If the patient has diarrhea, record its frequency, amount, color, and consistency. If you detect excessive watery diarrhea or bleeding, prepare to administer an antidiarrheal, I.V. fluids and electrolytes and, possibly, blood transfusions.
Gender Cue: Homosexual males who report acute diarrhea and who have negative fecal ova and parasite cultures may be infected with chlamydial proctitis not associated with lymphogranuloma venereum. Because rectal cultures will probably be negative, treatment with tetracycline is appropriate.
History and physical examination
If you’ve ruled out life-threatening conditions, obtain a detailed medical and surgical history. Ask the patient if he has had a hernia or abdominal surgery because these may cause mechanical intestinal obstruction. Does he have a history of inflammatory bowel disease? Also, ask about recent episodes of gastroenteritis among family members, friends, or coworkers. If the patient has traveled recently, even within the United States, was he aware of any endemic illnesses?
In addition, determine whether stress may have contributed to the patient’s problem. Ask about food allergies and recent ingestion of unusual foods or fluids. Check for fever, which suggests infection. Having already auscultated, now gently inspect, percuss, and palpate the abdomen.
Medical causes
Crohn’s disease
Hyperactive bowel sounds usually arise insidiously in Crohn’s disease. Associated signs and symptoms include diarrhea, cramping abdominal pain that may be relieved by defecation, anorexia, low-grade fever, abdominal distention and tenderness and, in many cases, a fixed mass in the right lower quadrant. Perianal and vaginal lesions are common. Muscle wasting, weight loss, and signs of dehydration may occur as Crohn’s disease progresses.
Food hypersensitivity
Malabsorption—typically lactose intolerance—may cause hyperactive bowel sounds. Associated signs and symptoms include diarrhea and, possibly, nausea and vomiting, angioedema, and urticaria.
Gastroenteritis
Hyperactive bowel sounds follow sudden nausea and vomiting and accompany “explosive” diarrhea. Abdominal cramping or pain is common, often after a peristaltic wave. Fever may occur, depending on the causative organism.
GI hemorrhage
Hyperactive bowel sounds provide the most immediate indication of persistent upper GI bleeding. Other findings include hematemesis, coffee-ground vomitus, abdominal distention, bloody diarrhea, rectal passage of bright red clots and jellylike material or melena, and pain during bleeding. Decreased urine output, tachycardia, and hypotension accompany blood loss.
Mechanical intestinal obstruction
Hyperactive bowel sounds occur simultaneously with cramping abdominal pain every few minutes in patients with mechanical intestinal obstruction—a potentially life-threatening disorder. Bowel sounds may later become hypoactive and then disappear. Nausea and vomiting occur earlier and with greater severity in small-bowel obstruction than in large-bowel obstruction. In complete bowel obstruction, hyperactive sounds are also accompanied by abdominal distention and constipation, although the part of the bowel distal to the obstruction may continue to empty for up to 3 days.
Ulcerative colitis (acute)
Hyperactive bowel sounds arise abruptly in patients with ulcerative colitis and are accompanied by bloody diarrhea, anorexia, abdominal pain, nausea and vomiting, fever, and tenesmus. Weight loss, arthralgia, and arthritis may occur.
Special considerations
Prepare the patient for diagnostic tests, which may include endoscopy to view a suspected lesion, barium X-rays, or stool analysis.
Pediatric pointers
Hyperactive bowel sounds in children usually result from gastroenteritis, erratic eating habits, excessive ingestion of certain foods (such as unripened fruit), or food allergy.
Patient counseling
Explain prescribed dietary changes to the patient. These may range from complete food and fluid restrictions to a liquid or bland diet. Because stress often precipitates or aggravates bowel hyperactivity, teach the patient relaxation techniques such as deep breathing. Encourage rest and restrict the patient’s physical activity.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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