ROSH Gastrointestinal Practice Exam

What is the characteristic physical examination finding in a patient with intestinal perforation?

1. Abdominal tenderness

2. Decreased bowel sounds

3. High-pitched bowel sounds

4. Absent reflexes

The correct answer is: High-pitched bowel sounds

In the context of intestinal perforation, high-pitched bowel sounds can be a characteristic finding during physical examination. This is reflective of increased intestinal activity response to irritation and can indicate that the bowels are still trying to function despite the perforation. When an intestinal perforation occurs, it leads to peritonitis due to the spillage of intestinal contents into the abdominal cavity. The body's response often involves reactive hyperperistalsis, which may present as high-pitched or tinkling bowel sounds upon auscultation. This is particularly noticeable early in the course after the perforation, as the stimulus for bowel activity increases. In contrast, abdominal tenderness is generally present in many gastrointestinal conditions and does not specifically indicate perforation. Decreased bowel sounds are more typically associated with significant intra-abdominal pathology or after a perforation has led to bowel paralysis or ileus. Absent reflexes are not relevant in the context of gastrointestinal perforation and tend to indicate neurological issues rather than gastrointestinal ones.