How to auscultate the abdomen

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.

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.

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.

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:

1. Aorta
2. Bilateral renal arteries
3. Bilateral iliac arteries
4. Hepatic artery
5. 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.

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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