Bowel sounds, hyperactive
Bowel sounds, hyperactive: Excerpt from Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They’re commonly characterized as rapid, rushing, gurgling waves of sound. (See Characteristics of bowel sounds.) They may stem from life-threatening bowel obstruction or GI hemorrhage, or from GI infection, inflammatory bowel disease (IBD), which usually follows a chronic course; food allergies; or stress.
Act Now: After detecting hyperactive bowel sounds, quickly check the patient’s vital signs and ask him about associated symptoms, such as abdominal pain, vomiting, and diarrhea. If cramping abdominal pain or vomiting is present, continue to auscultate for bowel sounds. If bowel sounds stop abruptly, suspect complete bowel obstruction. Prepare to assist with GI suction and decompression, give I.V. fluids and electrolytes, and prepare the patient for surgery.
Assessment
History
Determine if there’s a history of hernia or abdominal surgery because these may cause mechanical intestinal obstruction. Determine if there’s a history of IBD, eruptions of gastroenteritis among family members, friends, or coworkers. Ask if the patient has traveled recently, even within the United States.
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.Obtain a full medication history, including
over-the-counter medications.
ALERT: Homosexual males who report acute diarrhea and exhibit 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.
Physical examination
Check for fever, which suggests infection. Complete a full GI assessment by inspecting abdominal contour. Stoop at the recumbent patient’s side and then at the foot of his bed to detect localized or generalized distention. Auscultate the abdomen and note bowel sounds. Percuss and palpate the abdomen gently. Palpate for abdominal rigidity and guarding, which suggest peritoneal irritation that can lead to paralytic ileus.
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.
Geriatric pointers
Medication interactions and pre-existing diseases may produce pronounced symptoms in the elderly. Dehydration and fluid and electrolyte imbalances can quickly develop if there’s fluid loss present.
Medical causes
See Hyperactive bowel sounds: Causes and associated findings.
Crohn’s disease
Hyperactive bowel sounds usually arise insidiously. Associated signs and symptoms of Crohn’s disease 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 the disease progresses.
Food hypersensitivity
Malabsorption — typically lactose intolerance — may cause hyperactive bowel sounds. Associated signs and symptoms of food hypersensitivity 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, typically 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 intestinal obstruction, a potentially life-threatening disorder. Bowel sounds may later become hypoactive and then disappear. With small-bowel obstruction, nausea and vomiting occur earlier and with greater severity than in large-bowel obstruction. With 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.
Nursing considerations
Obtain the patient’s vital signs. Prepare him for diagnostic tests. These may include endoscopy to view a suspected lesion, barium X-rays, computed tomography scan, or stool analysis.
Monitor intake and output closely. If diarrhea is present, monitor for signs and symptoms of dehydration.
Patient teaching
Explain prescribed dietary changes to the patient. These may range from complete food and fluid restrictions to a liquid or bland diet. Because stress commonly 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: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
More About Crohn's disease
More Medical Textbooks Online about Crohn's disease
Review other book chapters online related to Crohn's disease:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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