Abdominal bruit

Peripheral vascular examination can detect evidence of atherosclerosis, which may present as aortic or abdominal bruits, distended veins, diminished or absent peripheral pulses, or lower extremity edema. 

The abdominal examination should include auscultation for bowel sounds and abdominal bruits and palpation for organomegaly, masses, and diffuse abdominal tenderness. 

Evidence of large vessel vasculitis Abdominal bruit Anti-hypertensive treatment... 

A complete history and physical examination should assess (1) presence or absence of cardiovascular risk factors or definite cardiovascular disease in the individual (2) family history of premature cardiovascular disease or lipid disorders (3) presence or absence of secondary causes of hyperlipidemia, including concurrent medications and (4) presence or absence of xanthomas, abdominal pain, or history of pancreatitis, renal or liver disease, peripheral vascular disease, abdominal aortic aneurysm, or cerebral vascular disease (carotid bruits, stroke, or transient ischemic attack). 

Patients with renal artery stenosis may have an abdominal systolic-diastolic bruit. 

The most common secondary causes of hypertension are fisted in Table 13-1. A complete medical evaluation may provide clues for diagnosing secondary hypertension. For example, patients with coarctation of the aorta may have diminished or even absent femoral pulses, and patients with renal artery stenosis may have an abdominal systohc-diastolic bruit. 

The peripheral vasculature is considered a target organ. Physical examination of the systemic vasculature can detect evidence of atherosclerosis, which may present as bruits (in the aortic, abdominal, and peripheral arteries), distended veins, diminished or absent peripheral arterial pulses, or lower extremity edema. Peripheral arterial disease is a clinical condition that can result from atherosclerosis, which is accelerated in hypertension. Other cardiovascular risk factors (e.g., smoking) can increase the hkelihood of peripheral arterial disease as well as all other forms of target-organ damage. 

Claudication is a clinical, easy to make diagnosis. Claudication of the upper extremities, although much less frequent than that of the lower extremities, is also a clinical diagnosis. The extremities should be examined carefully. Examination of the peripheral arterial system should include an evaluation of the volume and character of the arterial pulses of the carotids and of the arteries of the upper extremities the subclavian, the brachial, the radial, and the ulnar. Physical examination should definitely encompass the abdominal aorta for abnormal pulsations, ectasias and/or bruits, and the arteries of the lower extremities femoral, popliteal, dorsalis pedis, and posterior tibialis. The pulse volume can be graded on a scale of 0 to 4. In addition to palpation, physical examination of the peripheral arterial system should include auscultation over the carotids, auscultation over the subclavian arteries above, and below the mid-clavicular area. A bruit over the subclavian artery and disappearance of the radial pulse with compression of the subclavian artery is evidence for subclavian syndrome. On occasion, a bruit may be heard by auscultation deep in the axilla. The bruit, a composite of low frequency sounds, is better appreciated when the examiner is using the bell of the stethoscope. 

Auscultation for abdominal and femoral bruits is a must in evaluating any patient. 

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