Abdominal compartment syndrome: Difference between revisions
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==Management== | ==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 | |||
*Nasogastric and bladder decompression | |||
* | *[[electrolyte repletion]] | ||
* | *[[Antibiotics]] | ||
*[[Pressors]] | |||
*CRRT | |||
*Percutaneous fluid drainage | |||
===Operative=== | |||
''Definitive treatment'' | |||
*Laparotomy provides decompression | |||
**High complication rate | |||
**No guidelines for timing of closure | |||
==Disposition== | ==Disposition== | ||
Revision as of 05:34, 8 January 2017
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
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
- 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
- Nasogastric and bladder decompression
- electrolyte repletion
- Antibiotics
- Pressors
- CRRT
- Percutaneous fluid drainage
Operative
Definitive treatment
- Laparotomy provides decompression
- High complication rate
- No guidelines for timing of closure
Disposition
- Admit
See Also
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).