Auscultating the abdomen

Auscultation of the abdomen (using a stethoscope to listen) is used to assess bowel sounds and detect abnormalities. In this video, from our Abdominal Examination Essentials course, we look at a step-by-step method for ensuring that all areas of the abdomen are covered and how to tell when something is wrong.

Performing a great abdominal exam is a vital aspect of clinical practice. In this course, you’ll learn special techniques for evaluating the abdomen and how to correlate exam findings with relevant anatomy. You’ll learn the differential diagnoses associated with different regions of the abdomen and confidently refer symptomatic patients for further testing or therapeutic interventions.

Auscultation of the abdomen, the use of the stethoscope to listen, is to generally assess bowel sounds and bruits, or murmurs. 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 skin of the patient.

Listen for bowel sounds in the abdomen to the right of the umbilicus, where the mid portion of the small bowel is located. Proceed to listen to all four quadrants. Normally, bowel sounds are low pitched, gurgling sounds that occur every five to 10 seconds, with peristalsis or bowel movement.

Note that this frequency varies per person, therefore listen for at least two minutes before concluding that the bowel sounds are absent. Absence of bowel sounds for greater than two minutes of listening may indicate that there is no peristalsis, which usually implies an ileus. Very high pitch bowel sounds can be associated with a mechanical obstruction, such as a small bowel obstruction, which increases the volume and frequency of bowel sounds.

Here is a demonstration of auscultation of all four quadrants. Listen for at least five to 10 seconds in each quadrant. Auscultation for bruits is an important part of the exam. A bruit is an abnormal swishing, or blowing sound from blood flowing through a narrow, or partially occluded artery. It can be thought of as a vascular murmur.

Please note a bruit is auscultated or heard, versus a thrill which has a similar pathology, but is palpated. There are five areas in the abdominal exam to auscultate a bruit, the aorta, bilateral renal arteries, bilateral iliac arteries, hepatic artery and the splenic artery. Place the stethoscope about two thirds down from the xiphoid for epigastrium, between it and the umbilicus for the aorta.

Place the stethoscope about three centimeters superior and lateral to the umbilicus on both the left and right side for the bilateral renal arteries. On some people this might be approximated by drawing an imaginary line down the point just proximal to the midclavicular line. Place the stethoscope about three centimeters inferior and lateral to the umbilicus on both the left and right side, for the iliac arteries.

Place the stethoscope along the right costal margin laterally at approximately the midclavicular line for the hepatic artery. Place the stethoscope along the left costal margin, approximately two centimeters inferior and lateral moving posteriorly to the midclavicular line. This accounts for the posterior location of the spleen, for the splenic artery. Auscultate for bruits over the aorta, bilateral renal arteries and bilateral iliac arteries.