Well hello there, #medtwitter! In this morning’s #meded byte, we’re myth-busting the physical exam with a post from our #staysharp series.
Our question for today:
Are bowel auscultations worth the gurgle?
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Our question for today:
Are bowel auscultations worth the gurgle?
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Let’s bring it back to fundamentals.
In med school, we learn that the pitch of a bowel sound is meant to shift our differential. For instance, low-pitched sounds might make you favor a diagnosis of ileus.
(As an aside, can anyone spell borborygmi right on the 1st try?)
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In med school, we learn that the pitch of a bowel sound is meant to shift our differential. For instance, low-pitched sounds might make you favor a diagnosis of ileus.
(As an aside, can anyone spell borborygmi right on the 1st try?)
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Here’s the catch: bowel sounds aren’t terribly reliable!
The test characteristics of auscultation say it all. Our review of the available literature indicated that bowel sounds have low sensitivity and PPVs for diagnosis things like ileus.
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The test characteristics of auscultation say it all. Our review of the available literature indicated that bowel sounds have low sensitivity and PPVs for diagnosis things like ileus.
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And as it turns out, we can’t really use bowel auscultation to localize pathology to a specific quadrant.
Moreover, you may listen and not hear anything at all - because our gut gurgles are on looooong cycles and can be quiet for several minutes at a time.
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Moreover, you may listen and not hear anything at all - because our gut gurgles are on looooong cycles and can be quiet for several minutes at a time.
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Lastly, bowel sounds have low levels of inter-observer agreement.
Makes us feel better for all the times we listened to a patient’s abdomen right after our co-resident and found ourselves reporting a completely different exam.
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Makes us feel better for all the times we listened to a patient’s abdomen right after our co-resident and found ourselves reporting a completely different exam.
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BUT may still see members of the #CoreIM team putting stethoscopes on our patients’ bellies.
When? In suspected bowel obstruction. We’d expect high-pitched or absent sounds so presence of normal sounds lowers the probability of obstruction (LR = 0.4).
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When? In suspected bowel obstruction. We’d expect high-pitched or absent sounds so presence of normal sounds lowers the probability of obstruction (LR = 0.4).
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Phewph! That’s a lot of evidence-sifting.
Thanks to @AGoodwinMD and @gabmayer for digging this up!
As always, let us know if you like this feature and want to see more of it. We love feedback!
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Thanks to @AGoodwinMD and @gabmayer for digging this up!
As always, let us know if you like this feature and want to see more of it. We love feedback!
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P.S. Check out the references we cited on our website (did you know we have a website?!)
coreimpodcast.com/2020/01/08/gut……
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coreimpodcast.com/2020/01/08/gut……
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