Health Assessment, part 37: Bowel Sounds & Additional Assessments

Hi. I'm Meris, and in this video, I'm going to be talking to you about assessing bowel sounds, rebound tenderness, Murphy's sign, and McBurney's point. I'm going to be following along using our health assessment flashcards. These are available on our website, leveluprn.com, if you want to grab a set for yourself. Or if you prefer digital products, I would invite you to check out Flashables, which are the digital versions of all of our flashcards. All right. Let's go ahead and get started.

So first up, we are talking about the different types of bowel sounds that you may hear. Now, the normal or expected finding is to hear some high-pitched clicking or gurgling sounds, which are sometimes described as cascading sounds. And these should occur irregularly. They don't happen in any sort of a rhythm. But you should hear about 5 to 30 of these sounds over a given minute. You're familiar with these sounds, though. You have definitely heard bowel sounds before, even if you've never had a stethoscope in your ears. You've heard what it sounds like when your stomach grumbles or makes some sort of a noise as food gets passed through it. That's what we would expect to hear when we put that stethoscope down, and we listen to those bowel sounds.

Now, hypoactive, hypo meaning less than or smaller amount than expected. Hypoactive, your patient is going to have bowel sounds, however, they're going to be diminished, and they're going to indicate that there's less motility through that bowel. It's also possible for our patient to have completely absent bowel sounds. However, it's possible that I'm just hearing hypoactive sounds. So I really need to distinguish between hypoactive and absent by listening for five full minutes before I say that my patient has absent bowel sounds. I cannot call them absent unless I hear nothing for five entire minutes.

Now, hyperactive bowel sounds, this is going to be where your patient is experiencing more frequent bowel sounds than expected. These may also be louder. And the word for this is borborygmus. That's one single loud bowel sound. Or borborygmi is the condition of having multiple hyperactive, loud bowel sounds. This indicates increased motility. So perhaps this is just in relation to how much food your patient is moving through their intestines. Maybe they had a really big meal, and they got a lot to get through there. Or it could suggest that your patient is actually having a faster GI motility time, which can be indicative of some types of conditions such as dumping syndrome or something similar. So that is the different types of bowel sounds that you may be hearing for your patient.

Now let's move on to some additional abdominal assessments. I want to talk to you about rebound tenderness. Now, rebound tenderness is the sensation a patient has where they experience more pain, not when you push down on their abdomen, but when you release your hand from their abdomen. This is also sometimes called Bloomberg's sign. And Bloomberg's sign, or rebound tenderness, I'm going to push on the abdomen away from the source of pain. So for instance, if my patient has pain in the right lower quadrant, I'm going to assess for rebound tenderness on the left lower quadrant. I'm going to ask my patient, "Tell me if it hurts more when I push in or when I release." I'm then going to push in, and then I'm going to quickly release my hand away from that area. It will be pretty obvious if the patient has rebound tenderness because they will yelp or grimace or guard or something when you release the palpation versus when you cause the pressure initially. This may be indicative of acute appendicitis or peritonitis. If I have peritonitis where that entire peritoneum is inflamed, rebound tenderness or a positive Bloomberg sign is also possible.

Now let's talk about Murphy's sign. And gosh, don't these people love putting their last names on everything? So Murphy was the guy who discovered this. And Murphy's sign is also sometimes called inspiratory arrest. And I'm going to explain to you why and what this is. So we are going to take our fingers, and we are going to push up against the right costal margin, meaning that I'm going to push my fingers up underneath the ribs on the right side. And I am going to ask the patient then to inhale. If my patient is experiencing some kind of a gallbladder inflammation, or potentially some liver problems, but most specifically, gallbladder inflammation or infection, cholelithiasis, cholelithosis, any of these different kinds of cholecystitis, all of these different things, if my patient is experiencing a gallbladder issue, and I go to put my fingers underneath that right costal margin, and I ask them to take a deep breath, they are not going to be able to. They're going to hold their breath or perhaps they try to start taking that first inhale, but then they stop suddenly. Inspiratory arrest. They go to inhale, but then it hurts so bad that they stop. They have inspiratory arrest or a positive Murphy's sign. This, again, could be indicative of cholelithiasis or cholecystitis, and it needs further investigation. The expected finding is that there is no reaction. My patient is able to tolerate it and take a deep breath with my fingers in that location.

Okay. Lastly, let's talk about McBurney's point. Now, McBurney's point is a specific anatomical location that you need to know, which occurs at two-thirds of the distance between the umbilicus and the right iliac crest. That location in that right lower quadrant there, that specific point, is right over where the appendix hangs off there at the ileocecal junction. And if I have acute appendicitis, it is very likely that as that progresses, I will develop pain at McBurney's point. So you need to be aware that if your patient takes one finger and points right there to McBurney's point, it is possible that they are experiencing acute appendicitis, and you need to investigate further.

All right. Now let's test your knowledge of key facts I provided in this video with some quiz questions. How long must the nurse auscultate the abdomen before determining that the patient has absent bowel sounds? Five minutes. Where is the location of McBurney's point? Two-thirds the distance from the umbilicus to the right iliac crest. When assessing for Murphy's sign, the patient suddenly holds their breath. Is this unexpected or unexpected finding? Unexpected. This could indicate cholecystitis.

All right. That is it for this video. I hope you learned something. How many of those quiz questions did you get right? Let me know in the comments. And listen, if you have a great way to remember something different from what I said, would you leave me a comment? I love hearing the different ways that you remember things, and I know it's beneficial to other learners as well. All right. Thanks so much, and I'll see you in the next one. Happy studying.