Peristaltic waves, visible
With intestinal obstruction, peristalsis temporarily increases in strength and frequency as the intestine contracts to force its contents past the obstruction. As a result, visible peristaltic waves may roll across the abdomen. Typically, these waves appear suddenly and vanish quickly because increased peristalsis overcomes the obstruction or the GI tract becomes atonic. Peristaltic waves are best detected by stooping at the patient’s side and inspecting his abdominal contour while he’s in a supine position.
Visible peristaltic waves may also reflect normal stomach and intestinal contractions in thin patients or in malnourished patients with abdominal muscle atrophy.
History and physical examination
After observing peristaltic waves, collect pertinent history data. Ask about a history of a pyloric ulcer, stomach cancer, or chronic gastritis, which can lead to pyloric obstruction. Also ask about conditions leading to intestinal obstruction, such as intestinal tumors or polyps, gallstones, chronic constipation, and a hernia. Has the patient had recent abdominal surgery? Make sure to obtain a drug history.
Determine if the patient has related symptoms. Spasmodic abdominal pain, for example, accompanies small-bowel obstruction, whereas colicky pain accompanies pyloric obstruction. Is the patient experiencing nausea and vomiting? If he has vomited, ask about the consistency, amount, and color of the vomitus. Lumpy vomitus may contain undigested food particles; green or brown vomitus may contain bile or fecal matter.
Next, with the patient in a supine position, inspect the abdomen for distention, surgical scars and adhesions, or visible loops of bowel. Auscultate for bowel sounds, noting high-pitched, tinkling sounds. Then jar the patient’s bed (or roll the patient from side to side) and auscultate for a succussion splash — a splashing sound in the stomach from retained secretions due to pyloric obstruction. Palpate the abdomen for rigidity and tenderness, and percuss for tympany. Check the skin and mucous membranes for dryness and poor skin turgor, indicating dehydration. Take the patient’s vital signs, noting especially tachycardia and hypotension, which indicate hypovolemia.
Medical causes
Large-bowel obstruction
Visible peristaltic waves in the upper abdomen are an early sign of large-bowel obstruction. Obstipation, however, may be the earliest finding. Other characteristic signs and symptoms develop more slowly than in small-bowel obstruction. These include nausea, colicky abdominal pain (milder than in small-bowel obstruction), gradual and eventually marked abdominal distention, and hyperactive bowel sounds.
Pyloric obstruction
Peristaltic waves may be detected in a swollen epigastrium or in the left upper quadrant, usually beginning near the left rib margin and rolling from left to right. Related findings include vague epigastric discomfort or colicky pain after eating, nausea, vomiting, anorexia, and weight loss. Auscultation reveals a loud succussion splash.
Small-bowel obstruction
Early signs of mechanical obstruction of the small bowel include peristaltic waves rolling across the upper abdomen and intermittent, cramping periumbilical pain. Associated signs and symptoms include nausea, vomiting of bilious or, later, fecal material, and constipation; in partial obstruction, diarrhea may occur. Hyperactive bowel sounds and slight abdominal distention also occur early.
Special considerations
Because visible peristaltic waves are an early sign of intestinal obstruction, monitor the patient’s status and prepare him for diagnostic evaluation and treatment. Withhold food and fluids, and explain the purpose and procedure of abdominal X-rays and barium studies, which can confirm obstruction.
If tests confirm obstruction, nasogastric suctioning may be performed to decompress the stomach and small bowel. Provide frequent oral hygiene, and watch for a thick, swollen tongue and dry mucous membranes, indicating dehydration. Frequently monitor the patient’s vital signs and intake and output.
Pediatric pointers
In infants, visible peristaltic waves may indicate pyloric stenosis. In small children, peristaltic waves may be visible normally because of the protuberant abdomen, or visible waves may indicate bowel obstruction stemming from congenital anomalies, volvulus, or swallowing a foreign body.
Geriatric pointers
In elderly patients who present with visible peristaltic waves, always check for fecal impaction, which is a common problem among those of this age-group. Also, obtain a detailed drug history; antidepressants and antipsychotics can predispose patients to constipation and bowel obstruction.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Visible peristalsis
Read excerpts from these other book chapters related to Visible peristalsis:
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Visible peristalsis
» Next page: Bowel sounds, hyperactive (Professional Guide to Signs & Symptoms (Fifth Edition))
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