Symptom finder - The causes of visible peristalsis

Symptom finder - The causes of visible peristalsis
The causes of visible peristalsis waves generally are small bowel obstruction, large bowel obstruction and pyloric obstruction. In elderly, the causes of visible peristalsis waves are due to fecal impaction, drug intakes such as antipsychotic or antidepressant which lead to constipation and bowel obstruction. In children, pyloric stenosis ( common in infants ), protuberant abdomen ( small children) and swallowing foreign bodies or congenital anomalies such as volvulus may also present with visible peristalsis waves. Visible peristalsis waves may also occur with normal stomach, patient who is malnourished and atrophy of the abdominal muscle and contraction of the intestine in normal but thin patient.
As intestinal obstruction ( large or small bowel obstruction) are the common causes of visible peristalsis waves , always consider the present the treatment of intestinal obstruction in patient presenting with visible peristalsis waves. The patient clinical status is monitored and with hold food and fluid intake. Continue with abdominal x ray and barium studies. If intestinal obstruction is confirmed, the small bowel and stomach are decompressed with nasogastric suctioning. Watch for any signs of dehydration such as dry mucous membrane and thick swollen tongue. The patient ‘s vital signs are frequently observed.
The small bowel obstruction may present with visible peristalsis rolling waves as the initial signs of mechanical obstruction across the upper abdomen. Patient may complain of cramping intermittent periumbilical pain. On examination, slight distended abdomen and hyperactive bowel sounds are common. Patient generally complain of diarrhea ( partial obstruction), constipation, nausea, fecal material or bilious vomiting.
Large bowel obstruction may also present with peristalsis waves visible in the upper abdomen in the early stages of large bowel obstruction . Obstipation may also occur. Nausea colicky abdominal pain may progress slowly and midler than small bowel obstruction. Patient may also present with hyperactive bowel sound and abdominal distention.
Pyloric obstruction is characterized by visible waves of peristalsis from left upper `9 left rib margin ) which roll form left to right or from swollen epigastrium. Besides visible peristalsis wave, other findings are anorexia, nausea, vomiting, weight loss, colicky abdominal pain and vague epigastric discomfort with local succussion splash on auscultation.
Why do we have visible peristalsis waves? Peristalsis waves will temporarily increase in frequency and strength due to intestinal obstruction due to contraction of intestine to force the content past the obstruction. As a consequences , the wave of peristalsis become visible. The peristalsis wave may vanish suddenly due to increase in peristalsis overcomes the obstruction and the gastrointestinal tract become atonic. We need to stoop at the sides of the patient and inspecting the abdominal contour while the patient in supine position.
The important points to elicit while taking history from patient include past history of chronic gastritis, stomach cancer or pyloric ulcer. Point out any condition such as gallstones, polyps and tumors of the intestine , hernia or chronic constipation which lead to intestinal obstruction. The patient may have previous surgery to the abdomen . Patient with colicky abdominal pain may suffer from pyloric obstruction while patient with spasmodic abdominal pain may suffer from small bowel obstruction. Ask the patient regarding any episodes of vomiting and the nature amount and consistency of the vomit. Brown or green vomitus contain fecal or bile. Undigested food particles suggestive of lumpy vomitus.
Patient’s abdomen is inspected for any visible loops of bowel , adhesion, surgical scars and abdominal distention. The bowel is auscultated and listened for any high pitched tinkling sound. The patient is rolled from side to side and auscultate for a splashing sound in the stomach ( succussion splash) from secretion from pyloric obstruction. The abdomen is palpated for tenderness and rigidity. Percuss for tympany. Look for any evidence of dehydration such as poor skin turgor and dry skin and mucous membrane. Hypovolemia is suggestive by hypotension and tachycardia.
References
1.Weiland, Douglas, Daniel H. Dunn, Edward W. Humphrey, and Michael L. Schwartz. “Gastric Outlet Obstruction in Peptic Ulcer Disease: An Indication for Surgery.” The American Journal of Surgery 143, no. 1 (January 1982): 90–93. doi:10.1016/0002-9610(82)90135-0.
2.Glover, Donald M., and Frank McA. Barry. “Intestinal Obstruction in the Newborn.” Annals of Surgery 130, no. 3 (September 1949): 480–509.
3.Weiland, Douglas, Daniel H. Dunn, Edward W. Humphrey, and Michael L. Schwartz. “Gastric Outlet Obstruction in Peptic Ulcer Disease: An Indication for Surgery.” The American Journal of Surgery 143, no. 1 (January 1982): 90–93. doi:10.1016/0002-9610(82)90135-0.
The causes of visible peristalsis waves generally are small bowel obstruction, large bowel obstruction and pyloric obstruction. In elderly, the causes of visible peristalsis waves are due to fecal impaction, drug intakes such as antipsychotic or antidepressant which lead to constipation and bowel obstruction. In children, pyloric stenosis ( common in infants ), protuberant abdomen ( small children) and swallowing foreign bodies or congenital anomalies such as volvulus may also present with visible peristalsis waves. Visible peristalsis waves may also occur with normal stomach, patient who is malnourished and atrophy of the abdominal muscle and contraction of the intestine in normal but thin patient.
As intestinal obstruction ( large or small bowel obstruction) are the common causes of visible peristalsis waves , always consider the present the treatment of intestinal obstruction in patient presenting with visible peristalsis waves. The patient clinical status is monitored and with hold food and fluid intake. Continue with abdominal x ray and barium studies. If intestinal obstruction is confirmed, the small bowel and stomach are decompressed with nasogastric suctioning. Watch for any signs of dehydration such as dry mucous membrane and thick swollen tongue. The patient ‘s vital signs are frequently observed.
The small bowel obstruction may present with visible peristalsis rolling waves as the initial signs of mechanical obstruction across the upper abdomen. Patient may complain of cramping intermittent periumbilical pain. On examination, slight distended abdomen and hyperactive bowel sounds are common. Patient generally complain of diarrhea ( partial obstruction), constipation, nausea, fecal material or bilious vomiting.
Large bowel obstruction may also present with peristalsis waves visible in the upper abdomen in the early stages of large bowel obstruction . Obstipation may also occur. Nausea colicky abdominal pain may progress slowly and midler than small bowel obstruction. Patient may also present with hyperactive bowel sound and abdominal distention.
Pyloric obstruction is characterized by visible waves of peristalsis from left upper `9 left rib margin ) which roll form left to right or from swollen epigastrium. Besides visible peristalsis wave, other findings are anorexia, nausea, vomiting, weight loss, colicky abdominal pain and vague epigastric discomfort with local succussion splash on auscultation.
Why do we have visible peristalsis waves? Peristalsis waves will temporarily increase in frequency and strength due to intestinal obstruction due to contraction of intestine to force the content past the obstruction. As a consequences , the wave of peristalsis become visible. The peristalsis wave may vanish suddenly due to increase in peristalsis overcomes the obstruction and the gastrointestinal tract become atonic. We need to stoop at the sides of the patient and inspecting the abdominal contour while the patient in supine position.
The important points to elicit while taking history from patient include past history of chronic gastritis, stomach cancer or pyloric ulcer. Point out any condition such as gallstones, polyps and tumors of the intestine , hernia or chronic constipation which lead to intestinal obstruction. The patient may have previous surgery to the abdomen . Patient with colicky abdominal pain may suffer from pyloric obstruction while patient with spasmodic abdominal pain may suffer from small bowel obstruction. Ask the patient regarding any episodes of vomiting and the nature amount and consistency of the vomit. Brown or green vomitus contain fecal or bile. Undigested food particles suggestive of lumpy vomitus.
Patient’s abdomen is inspected for any visible loops of bowel , adhesion, surgical scars and abdominal distention. The bowel is auscultated and listened for any high pitched tinkling sound. The patient is rolled from side to side and auscultate for a splashing sound in the stomach ( succussion splash) from secretion from pyloric obstruction. The abdomen is palpated for tenderness and rigidity. Percuss for tympany. Look for any evidence of dehydration such as poor skin turgor and dry skin and mucous membrane. Hypovolemia is suggestive by hypotension and tachycardia.
References
1.Weiland, Douglas, Daniel H. Dunn, Edward W. Humphrey, and Michael L. Schwartz. “Gastric Outlet Obstruction in Peptic Ulcer Disease: An Indication for Surgery.” The American Journal of Surgery 143, no. 1 (January 1982): 90–93. doi:10.1016/0002-9610(82)90135-0.
2.Glover, Donald M., and Frank McA. Barry. “Intestinal Obstruction in the Newborn.” Annals of Surgery 130, no. 3 (September 1949): 480–509.
3.Weiland, Douglas, Daniel H. Dunn, Edward W. Humphrey, and Michael L. Schwartz. “Gastric Outlet Obstruction in Peptic Ulcer Disease: An Indication for Surgery.” The American Journal of Surgery 143, no. 1 (January 1982): 90–93. doi:10.1016/0002-9610(82)90135-0.