Abdominal auscultation: bowel sounds and bruits !

Exam technique

Listening to the abdomen with a stethoscope before touching it, to hear the gut working and any bruits over the arteries.

Updated 2026-11-01

See it in 3D: Abdominal aorta · Jejunum · Ileum · Kidneys

What it is

Auscultation is the second stage of the abdominal exam and is done before percussion and palpation, because those maneuvers can change bowel activity. You listen for two things: bowel sounds (borborygmi), which reflect the movement of gut contents, and vascular bruits over the aorta and the renal, iliac and femoral arteries. On its own its value is limited, but together with the history it helps with obstruction, ileus and vascular disease.

Landmark anatomy

Bowel sounds come from gas and fluid pushed along by peristalsis of the small bowel and colon.
The abdominal aorta projects onto the midline from the epigastrium to the umbilicus; the renal arteries leave it at about L1–L2.
The common iliac arteries run from the umbilicus toward the midpoint of each inguinal ligament.

Technique, step by step

Patient supine and relaxed, after inspection and before any palpation.
Warm the stethoscope diaphragm and rest it gently on the abdominal wall.
Listen for bowel sounds at one spot (for example the right lower quadrant); they usually carry across the abdomen.
Describe rate and pitch: normal, increased, reduced or absent; to call them absent, listen for several minutes.
Listen for bruits: aorta in the epigastric midline, renals beside it above the umbilicus, iliacs in the lower quadrants, femorals below the inguinal ligament.
Listen over the liver and spleen if a friction rub from capsular inflammation is suspected.
Record the finding with its site and context (fasting, recent surgery, opioid drugs).

Abnormal findings

Increased sounds (borborygmi heard even without a stethoscope): diarrhea, gastroenteritis, gastrointestinal bleeding, early obstruction.
High-pitched tinkling sounds in rushes with colicky pain: mechanical small bowel obstruction.
Reduced or absent sounds: paralytic ileus (after surgery, opioids, electrolyte disorders), peritonitis, late mesenteric ischemia.
Aortic or iliac bruit: atherosclerosis or aneurysm; systolic-diastolic renal bruit: renal artery stenosis.
Periumbilical venous hum: collateral circulation in portal hypertension (a rare finding).

Common errors

Palpating or percussing before listening changes the sounds and muddies the finding.
Calling sounds absent after a few seconds; auscultation is poorly reproducible and cannot rule out obstruction.
Pressing too hard with the bell or diaphragm can create a false bruit in thin people.

Test yourself

Think of the answer, then tap the question to see it.

Why do you listen to the abdomen before palpating it?

Percussion and palpation can stimulate or alter bowel activity and change the sounds you hear.

What do bowel sounds sound like in early mechanical obstruction?

Increased, high-pitched and tinkling, in rushes that match the colicky pain.

What does a silent abdomen after a period of increased sounds suggest?

A fatigued bowel with possible strangulation, ischemia or perforation; it is a red flag.

Where do you listen for a renal artery bruit?

In the epigastrium, on each side of the midline above the umbilicus, and also over the costovertebral angles.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Abdominal sounds: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine, 2025); Abdominal examination (Wikipedia, 2026); Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025).

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Representative model, for educational purposes only.