ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 278

Detecting abnormal bowel sounds by listening to the abdomen, preferably with a steth-
oscope, may be an exercise in futility for an inexperienced examiner. But the absence of
bowel sounds over a period of several minutes is an indication of ileus, usually resulting
from peritonitis. Conversely, the presence of hyperactive bowel sounds is consistent with
gastroenteritis.
Figure 20-1. Organs of the abdominal cavity
Palpation of the abdomen is critical for localizing the disorder but must be performed
gently, patiently and systematically ( Fig. 20-1 ) . The examiner's hands should be as warm
as possible to avoid inducing muscle spasm with cold fingers. The individual should be
asked to tell where the pain is greatest and to point with one finger to that site. The exam-
iner should stay away from that point during the initial examination; jabbing at the tender