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AUSCULTATION OF ABDOMEN

(For MD General Medicine Examination - GIT Section)

Auscultation of the abdomen is usually performed before palpation or percussion, as these maneuvers can alter bowel sounds. It provides insights into bowel activity and vascular sounds.

I. General Bowel Sounds

  1. Procedure:

    • Place the diaphragm of your stethoscope gently on the abdominal wall, typically starting in the right iliac fossa (RLQ), as bowel sounds are often most active here.

    • Listen for a minimum of one minute in each quadrant, or until bowel sounds are clearly heard.

  2. Observation:

    • Character:

      • Normal: Gurgling, clicking sounds, occurring irregularly at a frequency of 5-30 sounds per minute.

      • Increased (Hyperactive): Louder, more frequent, high-pitched "tinkling" sounds (e.g., in early intestinal obstruction, gastroenteritis, hunger). Often called borborygmi if loud and rumbling without a stethoscope.

      • Decreased (Hypoactive): Fewer than 5 sounds per minute (e.g., paralytic ileus, peritonitis, late intestinal obstruction).

      • Absent: No bowel sounds heard after listening for 5 minutes continuously in each quadrant (indicates severe conditions like paralytic ileus, diffuse peritonitis).

II. Vascular Sounds (Bruits)

  1. Procedure: Use the bell of your stethoscope (for low-pitched sounds) over specific arterial areas.

  2. Areas to Auscultate:

    • Aortic Bruit: Just above the umbilicus in the midline (for renal artery stenosis, aortic aneurysm).

    • Renal Artery Bruits: Approximately 2 cm superior and 2 cm lateral to the umbilicus on either side (for renal artery stenosis, which can cause hypertension).

    • Iliac Artery Bruits: Over the iliac arteries in the lower quadrants.

    • Femoral Artery Bruits: In the groin region (for peripheral vascular disease).

    • Hepatic Bruit: Over the liver (rare, can indicate hepatocellular carcinoma or severe alcoholic hepatitis).

    • Splenic Bruit: Over the spleen (rare, can indicate splenic aneurysm).

  3. Observation: Listen for high-pitched, blowing sounds. Note their location, timing (systolic, continuous), and loudness.

III. Friction Rubs

  1. Procedure: Use the diaphragm of your stethoscope over the liver and spleen.

  2. Observation: Listen for a rough, grating sound (like two pieces of leather rubbing together).

    • Hepatic Friction Rub: Over the liver (e.g., hepatic tumor, gonococcal perihepatitis - Fitz-Hugh-Curtis syndrome, liver abscess, recent liver biopsy).

    • Splenic Friction Rub: Over the spleen (e.g., splenic infarct, perisplenitis).

IV. Venous Hum

  1. Procedure: Place the bell of your stethoscope over the umbilicus or the surrounding dilated periumbilical veins (Caput Medusae).

  2. Observation: Listen for a soft, low-pitched, continuous sound with systolic accentuation.

  3. Clinical Significance: Indicates increased collateral circulation between the portal and systemic venous systems, as seen in severe portal hypertension. The sound may disappear with light pressure by the stethoscope or finger on the vein just above the area being auscultated.