Abdominal compartment syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics | *Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics | ||
*Also known as intrabdominal hypertension | *Also known as intrabdominal hypertension (IAH) | ||
==Causes== | ==Causes== | ||
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==Pathophysiology== | ==Pathophysiology== | ||
* | *Build up of fluid or blood within the peritoneum or retroperitoneum | ||
**And/or decrease in abdominal wall compliance | |||
*Causes increased pressure within cavity of fixed volume | |||
**Abdominal perfusion pressure = MAP - intrabdominal pressure | |||
*Hypoperfusion of abdominal organs | |||
*Restriction of diaphragmatic excursion | |||
*Impaired central venous return | |||
==Clinical Features== | ==Clinical Features== | ||
* | *Decreased central venous return | ||
**Increased JVP | |||
**Increased ICP | |||
**Decreased cardiac preload | |||
*Increased intrathoracic pressure | |||
**Decreased lung compliance | |||
**Decreased functional residual capacity | |||
**Worsened V/Q mismatch | |||
*Oliguria, renal failure | |||
*Bowel ischemia | |||
==Diagnosis== | ==Diagnosis== | ||
*Suspect ACS/IAH | |||
*Transduce bladder pressure | |||
** >20mmHg WITH new organ dysfunction | |||
*Physical exam is neither sensitive nor specific | |||
==Management== | |||
*Nonoperative: Often first line approach when no abdominal injury present<ref>Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).</ref> | |||
**Limit fluid resuscitation | |||
**Electrolyte repletion | |||
**ABX | |||
**Pressors | |||
**CRRT | |||
**Percutaneous fluid drainage | |||
*Operative: Definitive treatment | |||
**Laparotomy provides decompression | |||
***High complication rate | |||
***No guidelines for timing of closure | |||
==References== | |||
<references/> | |||
[[Category:GI]] [[Category:Surg]] [[Category:Critical Care]] | |||
Revision as of 17:42, 16 June 2015
Background
- Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics
- Also known as intrabdominal hypertension (IAH)
Causes
- Trauma
- Diffuse peritonitis
- Small bowel obstruction
- Large volume fluid resuscitation
- Retroperitoneal hemorrhage
- Reperfusion of ischemic bowel
- Acute Pancreatitis
- Ascites
Pathophysiology
- Build up of fluid or blood within the peritoneum or retroperitoneum
- And/or decrease in abdominal wall compliance
- Causes increased pressure within cavity of fixed volume
- Abdominal perfusion pressure = MAP - intrabdominal pressure
- Hypoperfusion of abdominal organs
- Restriction of diaphragmatic excursion
- Impaired central venous return
Clinical Features
- Decreased central venous return
- Increased JVP
- Increased ICP
- Decreased cardiac preload
- Increased intrathoracic pressure
- Decreased lung compliance
- Decreased functional residual capacity
- Worsened V/Q mismatch
- Oliguria, renal failure
- Bowel ischemia
Diagnosis
- Suspect ACS/IAH
- Transduce bladder pressure
- >20mmHg WITH new organ dysfunction
- Physical exam is neither sensitive nor specific
Management
- Nonoperative: Often first line approach when no abdominal injury present[1]
- Limit fluid resuscitation
- Electrolyte repletion
- ABX
- Pressors
- CRRT
- Percutaneous fluid drainage
- Operative: Definitive treatment
- Laparotomy provides decompression
- High complication rate
- No guidelines for timing of closure
- Laparotomy provides decompression
References
- ↑ Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).